[Margie]

HI

Does anyone know if there's a LOW-END limit on the # of enteral calories required PER DAY for Medicare to cover? If the pt is only taking 2 cans per day, will Medicare cover? We have a pt like this. Getting #720 cals per day.

Thanks!

[Lenore Gelman]

I don't know if there is a caloric minimum, however, the criterion has to be that the patient cannot swallow. If the patient is eating as well as received tube feeding they are not eligible for Medicare part b benefits. There are some exceptions - for example if the patient can swallow very limited amounts and is eating pleasure foods for therapeutic reasons only not to sustain life.. but ultimately if the patient is not able to swallow and not eating anything but receiving 700 calories via tube feeding (is that possible?) then they would probably be covered by Medicare Part B.fficeffice" />>>

[Margie]

pt can only have pureed foods because he can't swallow or chew...scrambled eggs, soups..wife doesn't think cals are more than the cals from tube feeds...

[Lenore Gelman]

If the patient is getting pureed food they can swallow in chich case they are not eligible. Sometimes there are exceptions. I think you should call Medicare to discuss the specific details of the case but it sounds like the patient is not eligible.

[SimplyLori]

In the old days Medicare's CMN used to have a question that asked if the calories per day were within a certain range per the weight of the patient - cals per kg. The last time I had a patient on a very low calorie count I looked up the old formula, made the calculation and was surprised to find them OK. The patient was very small. If I find the formula or remember it I'll re-post but at the moment its escaping me!

[Margie]

THANK YOU. I believe we found the formula...divide pt weight in pounds by 2.2. This gives pt weight in kilograms. Then, prescribed # of cals per day should be divided by pt's weight in kilograms. This indicates # of cals/KG the pt is infusing..... Use this to determine if pt is receiving less than 20cals/kg or more than 35 cals/kg.....
Thanks for your help.