Oral and Enteral Infant Nutritional Formula for Metabolic and Malabsorption Disorders
Defines medical necessity and coverage guidance for oral and enteral infant nutritional formulas—particularly for infants (≤12 months) with inborn errors of metabolism and for enteral nutrition in malabsorption—applicable to Cigna-administered health benefit plans.
Removed the not medically necessary items statement.
Removed policy statements for a long list of products including home enteral/parenteral infusion pumps, home parenteral nutrition, intradialytic parenteral nutrition, most specialized infant formulas except for inborn errors of metabolism, baby food, banked breast milk for non-hospitalized infants, dietary additives, gluten-free food products, grocery items for blenderized feeds, high protein powders, low carbohydrate diets, normal grocery items, nutritional supplement puddings, oral/enteral formulas used to replace fluids and electrolytes, oral vitamins/minerals, and weight-loss foods/formula.
Revised the benefit plan disclaimer.
Considered medically necessary if used to report infant nutritional formula for the treatment of inborn errors of metabolism.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.