Effective for dates of service on or after January 1, 2021, the following changes apply to the List of Enteral Nutrition Products Effective for Dates of Service on or After January 1, 2021.
- PediaSure Grow & Gain with and without Fiber, Bottles (4 products), billing codes 70074067532, 70074067534, 70074067536, 70074067538, were added with a MAC price of 0.0061. These product numbers were also removed from the Deletions tab of the List.
- Enfamil Neuro Pro EnfaCare 22 RTU, case 48 UPC Case Number has been updated to 300875122051
- PurAmino Jr. 400g, vanilla Medi-Cal Billing Code (NDC-like number) has been updated to 00087512244
- MCT Procal, unflav, 30x16g sachets, billing code 50600050236, was added to the Specialized product category. Previously, it was only listed as a Metabolic product
- Product Types revised to ensure alignment with the category criteria in the Provider Manual.
Product-Specific Criteria removed or updated for most products on the List. Please refer to the List of Enteral Nutrition Products Effective for Dates of Service on or After January 1, 2021 for specific product changes.
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