Which of the following is a Medicare criterion for home parenteral nutrition (HPN) eligibility?

• A. Massive small bowel resection ≤5 feet distal to the Ligament of Treitz
• B. Short bowel syndrome (enteral losses exceed 50% of enteral intake)
• C. Weight loss 50% in 3 months
• D. Serum albumin below 3.4 g/dL

Answer: (A)

Medicare eligibility for home parenteral nutrition centers on true intestinal failure due to substantial loss of functional small intestine. A major small bowel resection leaving only a very short segment distal to the Ligament of Treitz represents irreversible loss of absorptive surface, making home PN necessary. When residual small bowel length is about 5 feet or less, the patient is generally considered to have intestinal failure requiring parenteral nutrition at home, which is why this criterion is the best fit for Medicare coverage.

The other options don’t define Medicare eligibility. Enteral losses or short bowel syndrome by itself, weight loss percentage, or a low serum albumin aren’t used as Medicare criteria for HPN qualification.