Which of the following is NOT one of the three conditions for EN and PN to be covered under the Medicare Part B prosthetic device benefit?

• A. Regular performance of daily activities by the patient.
• B. Reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body part.
• C. Permanent impairment of long and indefinite duration (of at least 3 months).
• D. Provision of sufficient nutrients to maintain weight and strength commensurate with the patient's overall health status.

Answer: (A)

Medicare Part B prosthetic device coverage for enteral and parenteral nutrition rests on three elements: the nutrition must be reasonable and necessary for diagnosing or treating the illness or injury or to improve the functioning of a malformed body part; the impairment must be permanent or of long duration (typically at least 3 months); and the nutrition support must provide enough nutrients to maintain weight and strength appropriate to the patient’s overall health status. Regular performance of daily activities isn’t a criterion used to determine coverage, so that option doesn’t fit the three criteria.