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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that parenteral nutrition is the provision of nutritional requirements intravenously and is covered 
for beneficiaries who qualify under the Prosthetic Device Benefit defined in the Medicare Benefit Policy 
Manual (CMS Pub. 100-02), Chapter 15, Section 120. 
 
When nutritional support other than the oral route is necessary, enteral nutrition (EN) is usually initially 
preferable to parenteral nutrition for the following reasons: (1) In a fluid restricted beneficiary, EN permits 
delivery of all necessary nutrients in a more concentrated volume than parenteral nutrition; (2) EN allows for 
safer home delivery of nutrients; and (3) EN lowers the risk of Central Line-Associated Bloodstream Infections 
(CLABSI). 
 
For parenteral nutrition to be considered reasonable and necessary, the treating practitioner must document that 
enteral nutrition has been considered and ruled out, tried and been found ineffective, or that EN exacerbates 
gastrointestinal tract dysfunction. The beneficiary must have (a) a condition involving the small intestine and/or 
its exocrine glands which significantly impairs the absorption of nutrients or (b) disease of the stomach and/or 
intestine which is a motility disorder and impairs the ability of nutrients to be transported through and absorbed 
by the gastrointestinal (GI) system. The beneficiary must have a permanent impairment. Please refer to the 
LCD-related Policy Article for further guidance regarding the test of permanence.   
 
The treating practitioner is required to evaluate the beneficiary within 30 days prior to initiation of parenteral 
nutrition. If the treating practitioner does not see the beneficiary within this timeframe, they must document the 
reason why and describe what other monitoring methods were used to evaluate the beneficiary's parenteral 
nutrition needs. There must be documentation in the medical record supporting the clinical diagnosis. 
 
A total caloric daily intake of 20-35 cal/kg/day is considered reasonable and necessary to achieve or maintain 
appropriate body weight. The treating practitioner must document the medical necessity for a caloric intake 
outside this range in an individual beneficiary. 
 
The treating practitioner must document the medical necessity for protein orders outside of the range of 0.8-2.0 
gm/kg/day (B4168, B4172, B4176, B4178), dextrose concentration less than 10% (B4164, B4180), or lipid use per month in excess of the product-specific, FDA-approved dosing recommendations (B4185, B4187). 
 
Special nutrient formulas, HCPCS codes B5000, B5100, and B5200 are produced to meet the unique nutrient 
needs for specific disease conditions. The beneficiarys medical record must adequately document the specific 
condition and the necessity for the special nutrient. 
 
You can find these rules in the Local Coverage Determination (LCD) Parenteral Nutrition L38953. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.