TL;DR: The Centers for Medicare & Medicaid Services retired NCD 242 for Enteral and Parenteral Nutritional Therapy, effective January 1, 2022. Coverage decisions now fall to individual Medicare Administrative Contractors. Here's what that means for your billing team in 2026.
CMS enteral and parenteral nutritional therapy coverage policy no longer operates under a single national standard. The retirement of NCD 242 Medicare means your MAC — not CMS — decides whether a claim pays. This is a structural shift in how you document, appeal, and plan for reimbursement on these services.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Enteral and Parenteral Nutritional Therapy — RETIRED |
| Policy Code | NCD 242 |
| Change Type | Modified (NCD Retired) |
| Effective Date | January 1, 2022 (CMS documentation updated January 9, 2026) |
| Impact Level | High |
| Specialties Affected | Home infusion therapy, DME suppliers, gastroenterology, oncology, long-term care, hospital-based nutrition support teams |
| Key Action | Identify your MAC's local coverage determination for enteral and parenteral nutrition and update your documentation standards to match it |
CMS Enteral and Parenteral Nutrition Coverage Criteria and Medical Necessity Requirements 2026
This is the real issue: there is no longer a single CMS coverage policy governing enteral and parenteral nutrition billing. The Centers for Medicare & Medicaid Services retired NCD 180.2 effective January 1, 2022. That retirement stands today.
What replaced it is not a new national policy. Coverage determinations now fall to each Medicare Administrative Contractor under Section 1862(a)(1)(A) of the Social Security Act.
In plain terms, medical necessity for enteral and parenteral nutrition is now a regional question. Your MAC defines the criteria. If you operate across multiple MAC jurisdictions, you may be working with different coverage standards in different states.
Because the policy does not list specific CPT or HCPCS codes, the NCD 242 Medicare retirement doesn't trigger a code-level billing change. But it absolutely triggers a documentation and coverage policy review at the local level. That distinction matters.
Coverage Indications at a Glance
The retired NCD 242 does not specify covered or non-covered indications at the national level. Coverage status is now MAC-specific. The table below reflects what the current federal policy says — and what it doesn't.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Enteral nutrition therapy | Determined by MAC | Per MAC LCD | No national standard; check your MAC's LCD |
| Parenteral nutrition therapy | Determined by MAC | Per MAC LCD | No national standard; check your MAC's LCD |
| National coverage standard | Retired | N/A | NCD 180.2 retired effective January 1, 2022 |
| Medical necessity criteria | MAC-defined | Per MAC LCD | Must meet 1862(a)(1)(A) of the Social Security Act |
If your MAC has not published a local coverage determination for enteral or parenteral nutrition, coverage decisions fall to individual claim-level review. That's the highest-risk scenario for claim denial, and it's worth flagging to your compliance officer.
CMS Enteral and Parenteral Nutrition Billing Guidelines and Action Items 2026
The retirement of NCD 242 has been in effect since 2022, but the January 9, 2026 documentation update is your reminder to make sure your billing processes reflect the new reality. If your team is still operating off the old national criteria, you're working from a policy that no longer exists.
| # | Action Item |
|---|---|
| 1 | Find your MAC's LCD today. Search your Medicare Administrative Contractor's website for the current local coverage determination on enteral nutrition and parenteral nutrition. If no LCD exists, contact your MAC's provider relations line and ask what documentation standard they apply at the claim level. |
| 2 | Update your medical necessity documentation templates. The old NCD had specific national criteria. Your MAC's LCD may have different — and sometimes stricter — criteria. Align your physician documentation, order language, and chart notes to your MAC's current standard, not the retired NCD. |
| 3 | Audit recent claims for claim denial patterns. Pull denials from the past 12 months for enteral and parenteral nutrition services. If you're seeing denials for medical necessity, the root cause may be documentation built around the retired NCD rather than your MAC's current criteria. |
| 4 | Train your billing team on MAC-specific billing guidelines. This is not a one-national-policy situation anymore. If your billers are in multiple MAC jurisdictions, they need jurisdiction-specific training. Run a short internal review before the end of Q1 2026. |
| 5 | Loop in your compliance officer if you're unsure how your MAC's LCD applies to your patient mix. The shift from national NCD to local LCD is a material compliance change. If you haven't formally reviewed your enteral and parenteral nutrition billing policies against your MAC's current LCD, do that now — not after a denial or audit. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Enteral and Parenteral Nutrition Under NCD 242
The retired NCD 242 does not list specific CPT, HCPCS Level II, or ICD-10-CM codes. CMS removed code-level guidance when it retired this national coverage determination.
This is not a gap in this article. The policy genuinely does not specify codes at the national level. Applicable billing codes for enteral and parenteral nutrition are now governed by your MAC's LCD, not by NCD 242.
What This Means for Your Charge Capture
Because NCD 242 Medicare no longer defines covered codes, your charge capture and denial management workflows must reference your MAC's LCD directly. There is no national code list to fall back on.
If your billing system has NCD 242 hardcoded as a coverage reference for enteral or parenteral nutrition claims, remove it. It's retired. Claims routed through that logic are working off a dead policy.
Where to Find Current Code Guidance
Go to your MAC's website. Search their LCD database for "enteral nutrition" or "parenteral nutrition." The LCD will list covered HCPCS codes, documentation requirements, and any applicable ICD-10 diagnosis codes for coverage. If your MAC has not published an LCD, check CMS's Coverage Database at cms.gov for any pending or active contractor-level guidance.
Why the Retirement of NCD 242 Still Matters in 2026
Some billing teams saw this retirement in 2022 and moved on. Many didn't. Four years later, the January 9, 2026 CMS documentation update is surfacing this change in policy feeds again — and for good reason.
The practical risk hasn't gone away. When a national coverage policy retires and gets replaced by MAC-level decisions, reimbursement becomes inconsistent across regions. A claim that pays cleanly under one MAC's LCD gets denied under another's. If you've had unexplained regional variation in your enteral or parenteral nutrition reimbursement rates, this structural change is likely part of the explanation.
Enteral and parenteral nutrition billing also sits at the intersection of multiple billing challenges: benefit category classification under Prosthetic Devices. That benefit category surprises some billers. Confirm your claims are routing to the correct benefit category for your MAC.
The bottom line is this: the CMS enteral and parenteral nutritional therapy coverage policy is now a local question. Treat it that way.
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