317:30-5-211.24. Parenteral nutrition
(a) Parenteral nutrition (PN). PN is the provision of nutritional requirements intravenously.
(b) Medical necessity. PN must be determined by a provider to be medically necessary and documented in the member's plan of care as medically necessary and used for medical purposes. A request by a qualified provider for PN in and of itself shall not constitute medical necessity. The Oklahoma Health Care Authority (OHCA) shall serve as the final authority pertaining to all determinations of medical necessity. Refer to Oklahoma Administrative Code (OAC) 317:30-5-211.2 and 317:30-3-1(f) for policy on medical necessity.
(c) Documentation. All documentation submitted to request services must demonstrate, through adequate objective medical records, evidence sufficient to justify the member's need for the service, in accordance with OAC 317:30-3-1(f)(2).
(1) Hospital records that have objective medical evidence supporting the clinical diagnosis; if applicable;
(2) A certificate of medical necessity;
(3) A prescription; and
(4) Caloric Intake.
(5) For full guidelines, please refer to www.okhca.org/mau.
(1) Supply kits are all inclusive, unbundled supplies (e.g., gloves, tubing, etc.) are not reimbursable for PN.
(2) Pumps are rented as a capped rental.