Any advice as to what types of feeding tube equipment is covered by Medicare?

I am interested in getting the one that allows you to program the amount and timing of the food..
Second question is regarding the "suction pump" used for oral care. My hope is to use the swabs to clean the mouth since food is pocketed and also to provide better oral hygiene. Does anyone know if this is a covered piece of equipment and for what diagnosis is it a covered piece of equipment...
Thanks in advance,
GraceofGod

Medicaid

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Grace - what you are referring to is ENTERAL NUTRITION THERAPY and it seems it is pretty complex to get through the Medicare system to have it paid for if this is to be done at home. The pump is a Medicare PROSTHETIC DEVICE BENEFIT and if it's going to be paid for my Medicare, it will be whatever is the least expensive and least sophisticated one for Medicare to pay for it.

I briefly looked into this last year when my mom fell& became 100% bedfast @ her NH and was evaluating just what to do for her long term care plan.

Now for ENT @ a NH or in a hospital, it is covered under Medicare Part A and that seems to be pretty straightforward for Medicare to pay if all the medical necessity requirements are filled out by their MD's. Now my mom is in her 90's and has dementia, so for her doing ENT does not make sense and so she instead went onto the hospice benefit of Medicare. Been on hospice for about a year now.

But it seemed to me, that if I was looking for ENT to be paid for by Medicare under Part B (which covers stuff @ home), it can be kinda hard to provide the justification for medical necessity. You have to have the MD's clearly document the need for the whole system - which is very expensive. The example I was given was that say the patient had jaw or neck cancer and had basically none of that part of their body intact, then they would qualify for ENT under Medicare (these would be far gone cancers from smoking usually); and even then, it would be provided just until the time they got reconstructive surgery done. BUT if it was the case where they had dementia and could not cognitively understand to eat and you are wanting the ENT system done to make "feeding" them easier, then those would not qualify for ENT. They would instead be better on hospice (another Medicare benefit). There are just a few providers of the machines & the liquids that have to be used in the machines too, and none of this is cheap or easily available to buy. So you need to make sure that it is approved and cleared by Medicare before you get the equipment otherwise you will have to private pay for all.

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The type of feeding method / equipment is determined by the MD and ordered through a Durable Medical Equipment provider licensed to accept Medicare. The MD also specifies the type of feeding liquid and the rate of flow. So you start by asking the MD to write the script, and then the supplier will provide you with the simplest equipment that will get the job done and you sign the contract so that Medicare will pay for 80% of the cost.
If the patient is on Hospice, all decisions are made by the Hospice team. Generally they do NOT approve fluid therapy or feeding tubes.

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You would definitely want to check with your loved one's doctor to see what they recommend and what is covered - and for what diagnosis.

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My husband became eligible for Medicare this year and when we signed up we got a huge book with covered conditions/medicines and equipment. You may want to contact your loved one's insurance carrier to get the information you need.

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If someone becomes hospice appropriate and already has for example a gastic tube in place hospice will continue to provide the liquid feeds. The only equipment I saw used in ten years was a simple funnel attached to the tube for each feed. IV nutrition is not usually part of a hospice care plan.
I don't know how a younger patient who could not take oral nutrition for example from an injury would be treated. Private insurance will vary greatly but over 65 Medicare is always primary.

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Any advice as to what types of feeding tube equipment is covered by Medicare?

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