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E
Product Name	Covered/ Denied	Explanation
ELASTIC STOCKING	D	non reusable supplies: not rental-type items.
ELECTRIC HOSPITAL BED		see HOSPITAL BED.
ELECTRIC WHEELCHAIR		see WHEELCHAIR.
ELEVATOR	D	convenience item; not primarily medical in nature.
EMESIS BASIN	D	convenience item; not primarily medical in nature.
ENTERAL NUTRITION AND SUPPLIES	C	Enteral Nutrition is covered for a patient who has one of the following conditions, either of which requires tube feedings to provide sufficient nutrients to maintain weight and strength commensurate with the patient's overall health status. Permanent non-function or disease of the structures that normally permit food to reach the small bowel or disease of the small bowel which impairs digestion and absorption of an oral diet The patient must have a permanent impairment. Permanence does not require a determination that there is no possibility that the patient's condition may improve sometime in the future. If the judgment of the attending physician, substantiated in the medical record, is that the condition is of long and indefinite duration (ordinarily at least 3 months), the test of permanence is considered met. A total caloric intake of 20-35 cal/kg/day is considered sufficient to achieve or maintain appropriate body weight in most patients. If the patient's caloric intake falls outside of this range, an explanation from the physician must be placed in the patient's file. Calculation weight = kilograms                cal/day       =   cal/kg/day    2.2                                           kilograms The ordering physician is expected to see the patient within thirty (30) days prior to the initial certification. If the physician did not see the patient within this time frame, he/she must document the reason why and describe what other monitoring methods were used to evaluate the patient's enteral nutrition needs (i.e., RN visits) Special Nutrients such as Glucerna are covered if documentation establishes medical necessity (i.e. allergy or intolerance to standard nutrients). NOT COVERED ENTERAL NUTRITION In situations involving temporary impairments or when the patient has a functioning gastrointestinal tract whose need for enteral is due to reasons such as: anorexia; or nausea associated with mood disorder; or end stage disease, etc. Enteral Supplies If the nutrition coverage requirements are met, all related supplies are also covered, including I.V. poles and enteral nutrition preparation. NOT COVERED ENTERAL SUPPLIES more than one month's supply of enteral nutrients, equipment or supplies for one month's prospective billing.
ENTERAL PUMP	C	If a pump is ordered, the claim must be accompanied by sufficient medical documentation to justify medical necessity, i.e., that gravity feeding is not satisfactory due to aspiration, diarrhea, dumping syndrome, administration rate less than 100 ml./hrs, blood glucose fluctuations, circulatory overloads or jejunostomy tube used for feeding.
EXERCISE EQUIPMENT	D	not primarily medical in nature.

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