CMS Pub. 100-04, ch. 20, § 100.2.2

Nutrition (PEN) Therapy

(Rev. 1, 10-01-03)

B3-3324, B3-4450

The PEN coverage is determined by information provided by the treating physician and

the PEN supplier. A completed certification of medical necessity (CMN) must

accompany and support initial claims for PEN to establish whether coverage criteria are

met and to ensure that the PEN therapy provided is consistent with the attending or

ordering physician's prescription. DME MACs ensure that the CMN contains pertinent

information from the treating physician. Uniform specific medical data facilitate the

review and promote consistency in coverage determinations and timelier claims

processing.

The medical and prescription information on a PEN CMN can be most appropriately

completed by the treating physician or from information in the patient's records by an

employee of the physician for the physician's review and signature. Although PEN

suppliers sometimes may assist in providing the PEN services, they cannot complete the

CMN since they do not have the same access to patient information needed to properly

enter medical or prescription information. A/B MACs (B) and DME MACs use

appropriate professional relations issuances, training sessions, and meetings to ensure that

all persons and PEN suppliers are aware of this limitation of their role.

When properly completed, the PEN CMN includes the elements of a prescription as well

as other data needed to determine whether Medicare coverage is possible. This practice

will facilitate prompt delivery of PEN services and timely submittal of the related claim.