Many insurance policies establish their own criteria for EN and PN, while others follow guidelines set forth by which program?

• A. Medicare
• B. CHIP
• C. Medicaid
• D. Social Security

Answer: (A)

Insurance plans often set their own criteria for when enteral or parenteral nutrition is covered, but many align with Medicare's guidelines because Medicare provides national coverage determinations through CMS. This creates a consistent benchmark for medical necessity and reimbursement that private payers commonly reference. Medicaid and CHIP may follow CMS guidance but with state-specific variations, and Social Security does not set medical nutrition coverage rules. So Medicare guidelines are the standard that many policies adopt.