Which diagnosis would meet Medicare Part B coverage criteria to qualify a beneficiary for home enteral nutrition?

• A. Aspiration pneumonia
• B. Anorexia
• C. Dysphagia
• D. Malnutrition

Answer: (C)

Medicare Part B coverage for home enteral nutrition hinges on a medical condition that makes meeting nutritional needs through eating at home impossible or unsafe, requiring tube feeding. A swallowing disorder like dysphagia directly explains why oral intake is insufficient or unsafe, creating a clear medical necessity for enteral nutrition at home. Aspiration pneumonia is a complication that can result from swallowing problems but does not by itself establish the diagnosis that triggers coverage. Anorexia and malnutrition describe states of inadequate intake, but they don’t inherently demonstrate a lasting, functional impairment requiring home tube feeding under Part B. Therefore, dysphagia best meets the coverage criteria.