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Updates to the List of Enteral Nutrition Products

December 31, 2019

Effective for dates of service on or after January 1, 2020, Nestlé HealthCare Nutrition is adding an additional flavor for the currently contracted product, Peptamen Junior, 1.5, Vanilla, 24x250ml, and updating select “UPC Numbers (Item)” to the List of Enteral Nutrition Products.

The manufacturers guarantee providers can purchase the listed products at or below the maximum acquisition cost (MAC), upon request, for dispensing to Medi-Cal fee-for-service outpatient beneficiaries. Refer to the Enteral Nutrition Products section of the appropriate Part 2 manual for the MAC price suppliers' telephone numbers.

Note:

Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the beneficiary and claimed for reimbursement by the provider.

The amount reimbursed to providers for enteral nutrition products shall not exceed the published estimated acquisition cost (EAC) plus a 23 percent markup.

Medi-Cal beneficiaries denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or 1-855-795-0634 or by sending a written request to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA 94244-2430

An updated spreadsheet will be released in a future Medi-Cal Update.