CMS Retires NCD 242: What the End of the Enteral and Parenteral Nutrition National Coverage Determination Means for Your Billing Team

CMS has officially retired NCD 242, the longstanding National Coverage Determination for Enteral and Parenteral Nutritional Therapy, shifting coverage authority away from a uniform federal standard. This change—effective January 1, 2022 and formalized in subsequent policy updates—means your MAC, not CMS, now controls whether these claims get paid. If your organization bills for tube feeding, total parenteral nutrition (TPN), or related nutrition support services, this policy shift has direct implications for how you document medical necessity and where you look for coverage guidance.

What Changed: CMS Retires NCD 242 for Enteral and Parenteral Nutritional Therapy

The Centers for Medicare & Medicaid Services made a formal determination that a National Coverage Determination is no longer appropriate for Enteral and Parenteral Nutritional Therapy. Under the previous NCD 180.2, CMS set a single national standard that applied uniformly to all Medicare claims for these services. That uniform standard is gone.

In its place, coverage decisions now fall to the Medicare Administrative Contractors (MACs) under Section 1862(a)(1)(A) of the Social Security Act—the standard "reasonable and necessary" framework. This is not a coverage denial at the national level; it is a devolution of authority. The practical effect, however, is significant: coverage criteria can now vary depending on which MAC jurisdiction processes your claims.

This policy retirement was first effective January 1, 2022. The formal revision to the Medicare Benefit Policy Manual (Rev. 11892) was issued March 9, 2023, with an effective and implementation date of April 10, 2023. The policy code 242-v3 reflects the most recent documentation of this retired status as of March 12, 2026.

What "MAC Jurisdiction" Means for Enteral and Parenteral Nutrition Billing

When CMS retires an NCD, it does not leave a coverage vacuum—it transfers authority. Your MAC will now issue or maintain a Local Coverage Determination (LCD) or Local Coverage Article (LCA) that governs enteral and parenteral nutrition claims in your geographic region.

There are currently several MACs processing Medicare Part B claims across the country, including Noridian, Novitas, CGS, Palmetto GBA, First Coast, and others. Each may have its own medical necessity criteria, documentation requirements, and denial patterns for nutrition support services. A claim that would have sailed through under the old NCD may require more specific documentation under your MAC's LCD—or vice versa.

The benefit category classification for these services remains Prosthetic Devices under the Medicare benefit structure. This classification matters for how claims are coded and processed, and it should not have changed as a result of the NCD retirement.

Prior Authorization and Medical Necessity Under the New Framework

NCD 242 did not include specific prior authorization requirements at the national level, and that structure does not change here. However, your MAC's LCD may impose prior authorization or advance documentation requirements that were not previously mandated federally.

Medical necessity under 1862(a)(1)(A) requires that services be "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." For enteral and parenteral nutrition, this typically means documentation must support that the patient cannot absorb nutrients through the gastrointestinal tract in a normal manner, or that the condition necessitating nutrition support is severe enough to warrant the intervention.

Because medical necessity criteria are now locally defined, you need to map your clinical documentation standards to your specific MAC's requirements—not to a national standard that no longer exists.

Affected Codes

The policy document for NCD 242 (policy key 242-v3) does not list specific CPT or HCPCS codes. This is consistent with the retirement of the NCD—code-level coverage criteria are now the responsibility of each MAC's Local Coverage Determination.

What this means in practice: You cannot rely on this CMS policy document for a list of covered or non-covered codes. Pull your MAC's current LCD or LCA for enteral and parenteral nutrition to find applicable HCPCS codes (commonly B-codes for enteral and parenteral nutrition supplies and nutrients) and any associated ICD-10-CM diagnosis code requirements.

Do not use fabricated or assumed codes. Contact your MAC directly or access their LCD database at cms.gov/medicare-coverage-database for the authoritative code list in your jurisdiction.

What Your Billing Team Should Do