Nutritional therapy is a limited benefit and may be a covered when prescribed for dietary management of a covered disease or condition. A covered disease and/or condition may include: inborn errors of metabolism (IEM), medical conditions of malabsorption, pathologies of the alimentary tract or the gastrointestinal tract, and a neurological or physiological condition. Covered nutritional therapies include: enteral, parenteral and oral nutritional therapy. Additionally, intraperitoneal nutrition therapy is only covered for malnutrition as a result of end-stage renal disease. Any formula listed on the Enteral Nutrition Product Classification List is eligible for TRICARE cost-sharing when coverage criteria is met. See also banked donor milk.
Nutritional products that are marketed for use of individuals without medical conditions are not a covered benefit.
Nutritional therapy may be covered in an inpatient or outpatient setting. If covered, the setting where the services are provided will determine costs: outpatient office setting, home setting or inpatient hospital setting. Therapy administered by a registered dietician or nutritionist must be supervised by a physician.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.