Updates to The List of Enteral Nutrition Products

September 7, 2021

Effective for dates of service on or after September 1, 2021, the following Elemental and Semi-Elemental enteral nutrition products’ NDC-like billing codes have been updated and are available for reimbursement for manufacturer Ajinomoto Cambrooke:


Product Description Medi-Cal Billing Code (NDC-like number) UPC Number per Item (For Reference Only) UPC Number per Case (For Reference Only) MAC per gm or ml EAC per gm or ml
Essential Care Jr, 400g, Unflavored, Powder 24359080112 324359801126 None 0.0869 0.0885
Essential Care Jr, 400g x6, Unflavored, Powder 24359080113 324359801126 324359801133 0.0869 0.0885
Essential Care Jr, 400g, Vanilla, Powder 24359080212 324359802123 None 0.0869 0.0885
Essential Care Jr, 400g x6, Vanilla, Powder 24359080213 324359802123 324359802130 0.0869 0.0885
Essential Care Jr, 400g, White Chocolate, Powder 24359080312 324359803120 None 0.0869 0.0885
Essential Care Jr, 400g x6, White Chocolate, Powder 24359080313 324359803120 324359803137 0.0869 0.0885
Essential Care Jr, 400g, Citrus, Powder 24359080412 324359804127 None 0.0869 0.0885
Essential Care Jr, 400g x6, Citrus, Powder 24359080413 324359804127 324359804134 0.0869 0.0885

The contractors have guaranteed that Medi-Cal providers may purchase, upon request, for dispensing to eligible Medi-Cal fee-for-service outpatient beneficiaries, the products at or below the MAC with an approved Treatment Authorization Request (TAR) or a Service Authorization Request (SAR). Providers may locate MAC price suppliers by calling manufacturer phone numbers referenced in the List of Enteral Nutrition Products.

The List of Enteral Nutrition Products in the Enteral Nutrition Products (enteral) section of the Provider Manual will be updated in a forthcoming Medi-Cal Update.