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SUBJECT Insurance Coverage Request for EleCare or EleCare Jr (specify specific product)

SUBJECT Insurance Coverage Request for EleCare or EleCare Jr (specify specific product) 2025

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The document is a template letter for physicians to request insurance coverage and reimbursement for EleCare or EleCare Jr, amino acid-based formulas essential for the dietary management of patients with specific medical conditions. It includes sections for patient information, prescribed formula details, and justifications for the medical necessity of the product, emphasizing its role in treating various gastrointestinal and allergic disorders.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is EleCare a high calorie formula?

This formula is usually 20 calories per ounce, but sometimes a different calorie level may be needed to gain the right amount of weight.

Why do babies need EleCare?

EleCare is a nutritionally complete amino acid-based formula for infants with food allergies or GI conditions. Its hypoallergenic and clinically shown to support the growth of exclusively formula-fed infants.

How to get amino acid formula covered by insurance?

Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A, that the amino acid-based elemental infant formula is the

What are the indications for EleCare formula?

Elecare is used for: Providing nutrition in certain patients with severe food allergies or other conditions such as eosinophilic GI disorders (EGID), short syndrome, or malabsorption in which an amino acid-based diet is required.

Why would a baby need hypoallergenic formula?

Even when a severe allergy isnt present, babies with mild allergies and intolerances to milk protein may benefit from a hypoallergenic formula. Allergies to food and intolerances can wreak havoc on your babys comfort.

What is the procedure code for EleCare?

The HCPCS code for EleCare is B4161. Your approval of this request for coverage and reimbursement will make a significant difference in the health of this patient. This letter is intended to be used as a template and customized by the physician for each patient.

What is EleCare Jr.?

EleCare Jr is a hypoallergenic, nutritionally complete amino acid-based nutrition powder for children who cannot tolerate intact or hydrolyzed protein. With 100% free amino acids as the protein source, EleCare Jr supports growth and development.

Why would a baby need EleCare formula?

It is indicated for the dietary management of protein maldigestion, malabsorption, food allergies, short- syndrome, eosinophilic GI disorders, GI-tract impairment, or other conditions in which an amino acid-based diet is required. For infants 0 to 12 months of age.

SUBJECT Insurance Coverage Request for EleCare or EleCare Jr (specify specific product) 2025

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