According to CMS, which of the following is an indication for home parenteral nutrition?

• A. Bowel resection resulting in 5 feet small bowel beyond the ligament of Treitz
• B. Need for bowel rest of 2-4 weeks
• C. Lack of oral intake due to mild appetite
• D. Short bowel syndrome with intact digestion

Answer: (A)

CMS coverage for home parenteral nutrition is based on the presence of intestinal failure—the inability to maintain adequate nutrition and hydration without parenteral support for an extended period. If a bowel resection leaves about five feet of small bowel beyond the ligament of Treitz, the remaining absorptive surface is typically insufficient to meet daily nutrient needs through enteral feeding alone, making parenteral support necessary to prevent malnutrition and dehydration. The other scenarios describe temporary or mild issues (temporary bowel rest, limited oral intake, or short bowel syndrome with preserved digestion) that do not meet the long-term intestinal failure criterion for home PN. Therefore, the scenario with five feet of remaining small bowel is the indication for home parenteral nutrition.