List 3 aspects of home parenteral nutrition (HPN) that require specific justification for Medicare coverage.

• A. Calorie prescription outside the range of 20-35 calories per kg per day; Protein prescription outside the range of 0.8-1.5 grams per kg per day; Lipid use greater than 1500 grams per month
• B. Calorie intake consistent with 10-20 calories per kg per day; Vitamin supplementation only; No lipid restriction requirement
• C. Patient age under 18; Use of parenteral nutrition for less than 30 days; No need for caregiver training
• D. Daily weight stabilization alone justifies coverage

Answer: (A)

Medicare coverage for home parenteral nutrition hinges on proving medical necessity for the prescribed nutrition plan, and certain quantitative aspects of the prescription must be explicitly justified. The three aspects that routinely require justification are the daily energy dose, the daily protein amount, and the monthly lipid provision. If calories are prescribed outside the common range of 20–35 kcal/kg/day, or protein outside 0.8–1.5 g/kg/day, or lipid use exceeds about 1500 g per month, these deviations prompt a need for documented clinical justification showing why a PN approach is essential for that patient. The other options don’t capture these three specific quantitative criteria that Medicare typically requires to justify home PN.