DESCRIPTION
Intensive outpatient pediatric feeding programs or “feeding clinics” are interdisciplinary programs that have been proposed to provide assessment and management of individuals with persistent severe impairment in oral intake or absorption of oral intake of food that have affected a child’s ability to grow and develop. Some common types of feeding disorders during childhood include but are not limited to: adipsia (the absence of thirst); dysphagia (difficulty swallowing); food avoidance or refusal; an inability to self-feed; rigid food preferences; choking, gagging, or vomiting while eating; and difficulty transitioning from enteral feedings. Feeding disorders should not be confused with eating disorders, such as anorexia, which are common in adolescence and adulthood.
POLICY
An intensive outpatient pediatric feeding program is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
An intensive outpatient pediatric feeding program for the treatment of other conditions/diseases is considered investigational.
MEDICAL APPROPRIATENESS
An intensive outpatient pediatric feeding program is considered medically appropriate if ALL of the following are met:
Diagnosis of a feeding disorder and ANY ONE of the following:
Descent across 2 or more major weight percentiles (see Additional Information section for links to growth charts)
To facilitate transition from nutrition support (e.g., enteral feeding) to calorically appropriate foods
The program consists of an interdisciplinary team that is managed by a physician
Documentation includes a diagnosis-specific treatment plan and ALL of the following:
Specific interventions
Measurable goals
Estimated length of treatment
Medical concerns have been treated (e.g., acidosis, malabsorption, neurologic condition, reflux, renal insufficiency) without resolution of the feeding problem
Unresponsive to traditional therapy (e.g., occupational therapy, speech language pathologist/therapist, dietician)
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g., statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the medical policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
ADDITIONAL INFORMATION
Standard growth charts from the National Center for Health Statistics are available at the following links:
Birth to 24 months:
Boys, Weight-for-Age: https://www.cdc.gov/growthcharts/who/boys_length_weight.htm
Boys, Weight-for-Length: https://www.cdc.gov/growthcharts/who/boys_weight_head_circumference.htm
Girls, Weight-for-Age: https://www.cdc.gov/growthcharts/who/girls_length_weight.htm
Girls, Weight-for Length: https://www.cdc.gov/growthcharts/who/girls_weight_head_circumference.htm
Ages 2 to 20 years:
Males, Weight-for-Age: https://www.cdc.gov/growthcharts/html_charts/wtage.htm#males
Males, Weight-for-Stature: https://www.cdc.gov/growthcharts/html_charts/wtstat.htm#males
Females, Weight-for-Age: https://www.cdc.gov/growthcharts/html_charts/wtage.htm#females
Females, Weight-for-Stature: https://www.cdc.gov/growthcharts/html_charts/wtstat.htm#females
Growth charts for children with birth defects (e.g., Down syndrome) are available at: https://www.cdc.gov/ncbddd/birthdefects/types.html.
SOURCES
American Academy of Pediatrics. (2022, July). Recommendations for preventive pediatric health care. Retrieved February 9, 2023 from https://www.downloads.aap.org/AAP/PDF/periodicity_schedule.pdf.
American Speech-Language-Hearing Association. (2023) Pediatric feeding and swallowing. Retrieved February 6, 2023 from http://www.asha.org/public/speech/swallowing/feeding-and-swallowing-disorders-in-children.
Centers for Disease Control (CDC) and Prevention, National Center for Health Statistics. (2001) Data table of weight-for-age charts, ages 2-20 years. Retrieved February 6, 2023 from http://www.cdc.gov/growthcharts/html_charts.
Centers for Disease Control (CDC) and Prevention, National Center for Health Statistics. (2010) WHO growth charts. Data table for boys length-for-age and weight-for-age charts, birth to 24 months. Retrieved February 16, 2023 from http://www.cdc.gov/growthcharts/html_charts.
Centers for Disease Control (CDC) and Prevention, National Center for Health Statistics. (2010) WHO growth charts. Data table for girls length-for-age and weight-for-age charts, birth to 24 months. Retrieved February 16, 2023 from http://www.cdc.gov/growthcharts/html_charts.
Centers for Disease Control (CDC) and Prevention, Specific Birth Defects and Other Health Conditions. (2022, August). Special birth defects, down syndrome, growth charts. Retrieved February 15, 2023 from http://www.cdc.gov/ncbddd/birthdefects/downsyndrome/growth-charts.html.
Christian, V. J., Van Hoorn, M., Walia, C. L. S., Silverman, A., & Goday, P. S. (2021). Pediatric feeding disorder in children with short bowel syndrome. Journal of Pediatric Gastroenterology and Nutrition, 72 (3), 442-445. (Level 4 evidence)
Goday, P. S., Huh, S. Y., Silverman, A., Lukens, C. T., Dodrill, P., Cohen, S. S., et al. (2019). Pediatric feeding disorder: Consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition, 68 (1), 124-129. (Level 5 evidence)
Jung, J. S., Chang, H. J., & Kwon, J. Y. (2016). Overall profile of a pediatric multidisciplinary feeding clinic. Annals of Rehabilitation Medicine, 40 (4), 692–701. (Level 4 evidence)
National Institute for Health and Clinical Excellence. (2017, September). Faltering growth: recognition and management of faltering growth in children. Retrieved February 9, 2023 from www.nice.org.uk/guidance.
Sharp, W. G., Stubbs, K. H., Adams, H., Wells, B. M., Lesack, R. S., Criado, K. K., et al. (2016). Intensive, manual-based intervention for pediatric feeding disorders: Results from a randomized pilot trial. Journal of Pediatric Gastroenterology and Nutrition, 62(4), 658–663. (Level 2 evidence)
Sharp, W. G., Volkert, V. M., Scahill, L., McCracken, C. E., & McElhanon, B, et al. (2017). A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care? The Journal of Pediatrics, 181, 116–124.e4. (Level 2 evidence)
Sharp, W. G., Volkert, V. M., Stubbs, K. H., Berry, R. C., Clark, M. C., Bettermann, E. L., et al. (2020). Intensive multidisciplinary intervention for young children with feeding tube dependence and chronic food refusal: An electronic health record review. The Journal of Pediatrics, 223, 73–80.e2. Abstract retrieved February 10, 2023 from PubMed database.
Williams, C., VanDahm, K., Stevens, L. M., Khan, S., Urich, J., Iurilli, J., et al. (2017). Improved outcomes with an outpatient multidisciplinary intensive feeding therapy program compared with weekly feeding therapy to reduce enteral tube feeding dependence in medically complex young children. Current Gastroenterology Reports, 19 (7), 33. Abstract retrieved February 10, 2023 from PubMed database.
ORIGINAL EFFECTIVE DATE: 6/30/2023
MOST RECENT REVIEW DATE: 6/13/2024
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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