Under Medicare, the two criteria for home enteral nutrition are:

• A. A permanent non-function of the small bowel only
• B. A permanent non-function or disease of the structures that normally permit food to reach the small bowel; A disease of the small bowel that impairs digestion and absorption of an oral diet
• C. A permanent non-function or disease of any organ and a requirement for tube feeding
• D. A need for short-term tube feeding to treat a reversible condition

Answer: (B)

Medicare coverage for home enteral nutrition is based on a long‑term barrier to delivering nourishment to the gut. There are two scenarios that meet the criteria: either a permanent non-function or disease of the structures that normally permit food to reach the small bowel (such as the esophagus or stomach), or a disease of the small bowel that impairs digestion and absorption of an oral diet. In addition, there must be a clear need for tube feeding because oral intake cannot meet the patient’s nutritional requirements.

This combination is what the best option expresses: it covers both the structural barrier to delivering food to the small bowel and diseases of the small bowel that impede digestion/absorption, along with the necessity of tube feeding. The other choices are not aligned with Medicare's criteria: one is too narrow, focusing only on small bowel non-function and missing the structural route; another is too broad, implying any organ could qualify; and the last implies short‑term, reversible needs, which Medicare does not cover for home enteral nutrition.