This article was revised on August 10, 2022, to update the suspension time frame.
In support of members who may be affected by the powder infant formula shortage, AmeriHealth and AmeriHealth Administrators have extended the temporary suspension of the precertification requirement for nutritional formulas and enteral nutrition. Effective immediately through November 30, 2022, precertification will not be required for the following HCPCS codes:
All medical necessity criteria documented in our policies on nutritional formulas and enteral nutrition remain applicable during the temporary suspension of precertification for the codes listed above.
For detailed policy information, refer to Commercial policy #08.00.18o: Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk.
This temporary change is due to a nation-wide shortage of infant formula. On February 17, 2022, Abbott, a leading manufacturer of infant formula in the United States, voluntarily recalled some powder formulas manufactured in their Sturgis, Michigan facility. The recalled powder formulas include brand names Similac®, Alimentum®, and EleCare®.
For more information on the Abbott recall, including how to determine which formulas are impacted by the February 17, 2022, recall, go the to the Abbott Recall site or call 1-800-986-8540 and follow the instructions provided.