With Medicare guidelines, what is the critical condition required for HPN eligibility?

• A. Being over 65
• B. Partial obstruction alone
• C. Being malnourished
• D. Diagnosis of nonfunctional GI tract

Answer: (D)

Medicare coverage for home parenteral nutrition hinges on the gut being nonfunctional, meaning the intestine cannot meet the patient’s nutritional needs by feeding through the GI tract. When there is intestinal failure—a nonfunctional GI tract that requires intravenous nutrition to maintain nutrition—home PN is medically necessary and eligible for coverage. Age, partial obstruction by itself, or malnutrition alone do not establish eligibility because they do not demonstrate an inability of the gut to absorb nutrients. The key is the diagnosis of a nonfunctional GI tract (intestinal failure) that necessitates parenteral nutrition at home.