Enteral Nutrition

Enteral Nutrition consists of nutritional support given via the gastrointestinal (GI) tract, either directly or through any of a variety of tubes used in specific medical circumstances. This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, jejunostomy, or other tubes.

Enteral nutrition products may be covered upon authorization when used as a therapeutic regimen to prevent serious disability or death in patients with medically diagnosed conditions that preclude the full use of regular food. Enteral nutrition products covered are subject to the Medi-Cal List of Enteral Nutrition Products and utilization controls (XLSX).

Products on the Medi-Cal List of Enteral Nutrition Products are separately covered upon authorization for eligible Medi-Cal fee-for-service outpatients when supplied by a pharmacy provider upon the prescription of a licensed practitioner within the scope of his or her practice. For more information, see the Medi-Cal policy on Enteral Nutrition – English (PDF).

Prior Authorization

Please use the Prescription Drug Prior Authorization or Step Therapy Exception Request Form (No. 61-211) – English (PDF) for both Pump and Bolus (no pump) Enteral Nutrition. Cover page provides routing information for prior authorization form.

For members under 21 years old, please verify California Children Services (CCS) eligibility.

Medi-Cal Policies and Approved Products