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Reimbursement by Product

Kate Farms formulas are broadly eligible for insurance coverage including Medicare, Medi-Cal, and most Medicaid and private insurance plans. Coverage will depend on documented medical necessity for the patient and specific payor policies. We have national distribution available through major distributors and home care companies. Our formulas are the higher standard of enteral nutrition and without common allergens. Although Kate Farms formulas are plant-based and made with organic ingredients, you do not need extra documentation to prescribe Kate Farms. The documentation requirements are the same as all conventional formulas.

They are coded in these most commonly prescribed HCPCS categories:

Kate Farms Standard 1.0HCPCS B4150Intact Protein
Kate Farms Standard 1.4HCPCS B4150Intact Protein
Kate Farms Peptide 1.0HCPCS B4153Hydrolyzed Protein
Kate Farms Peptide 1.5HCPCS B4153Hydrolyzed Protein
Kate Farms Pediatric Standard 1.2HCPCS B4160Intact Protein for Pediatrics
Kate Farms Pediatric Peptide 1.0HCPCS B4161Hydrolyzed Protein for Pediatrics
Kate Farms Pediatric Peptide 1.5HCPCS B4161Hydrolyzed Protein for Pediatrics
Kate Farms Glucose Support 1.2HCPCS B4154Intact Protein
Kate Farms Renal Support 1.8HCPCS B4154Intact Protein

What information do I need to provide to check insurance coverage for my patient? A prescription indicating the following information:

  • Formula name
  • Length of need
  • Calories per day needed from formula
  • Method of administration
  • Prescribing physician Information (including practice address, phone number and physician’s NPI number)

Insurance providers, including state and private payors, often require additional patient health records in order to support a prescription and indicate medical necessity. Along with a prescription, the following information will likely be requested:

  • Patient demographics, including patient insurance information
  • Clinical notes from dietitian or physician indicating need for nutrition support
  • Patient history & physical

Please fax the above records to the patient’s current medical supply company or for assistance in finding an in-network medical supplier that provides Kate Farms formulas, please fax the documents above to Kate Farms Customer Care at 805-832-6119. Our team will contact the patient/caregiver once received.

Medicare Part B

Enteral nutrition benefits are covered under Medicare Part B. If patient meets Medicare qualification guidelines, then Part B pays 80% of allowable charges for medical equipment (DME) and beneficiary is responsible for the remaining 20% of the allowable amount. All of the following criteria must be met to qualify for tube feeding reimbursement:

  1. Diagnosis reflecting functional impairment of the gastrointestinal tract—Diagnosis code (ICD-9/ICD-10) must directly contribute to the nonfunctioning of part of the digestive tract.
  2. Permanent impairment—A condition is deemed permanent if enteral nutrition therapy is needed for long and/or indefinite duration, typically at least 90 days, as proved in the patient’s medical record.
  3. Tube feeding is required to “provide sufficient nutrients to maintain weight and strength commensurate with the patient’s overall health status.” Must be the primary source of nutrition for patient.

Medicaid

Medicaid plans often provide coverage for oral and tube feeding supplements. Each State Medicaid and Medicaid Managed Care Plan varies with unique program policies and guidelines. Coverage will depend on a patient’s diagnosed need for nutrition, prescribed calories needed from formula, age of patient, and whether or not a formulary list has been predetermined by the state or managed plan.

Private Insurance

Coverage of tube feeding and oral supplements through private insurance companies is determined by the individual policy. While many private insurance plans provide coverage for nutrition therapy and supplementation, check with a policy’s plan benefit manager for specific coverage information.

WIC

Kate Farms is available through a small number of State WIC1 programs. For a list of WIC Eligible Medical Foods in your state, check with your local WIC office to find out if a specific Kate Farms formula is available. Some states may have additional requirements before Kate Farms will be authorized for your patients.

1 WIC is a trademark of the US Department of Agriculture and an abbreviation of the Special Supplemental Nutrition Program for Women, Infants, and Children. No endorsement of any brand or product by the USDA is implied or intended.

Kate Farms Patient Assistance

Kate Farms is proud to offer patients who do not qualify for insurance coverage financial support in the form of a discount on orders made through katefarms.com. An application for this program may be completed by the patient, caregiver or healthcare provider at the following link: https://www.katefarms.com/for-clinicians/patient-assistance/