Enteral nutrition
Enteral nutrition may be partially reimbursed by health insurance in certain cases.
Those who are unable to feed themselves orally are often given liquid food via a tube . Tube feeding is also sometimes used in people with a disturbed intestinal function. The tube can be connected to the stomach via the nose (nasogastric).
If nutrition needs to be administered for a long period of time, it is often more comfortable for the patient to have a stomach stoma (percutaneous endoscopic gastrostomy or PEG), coupled with a tube connected to the small intestine.
The liquid feed can flow through the tube under the influence of gravity or be propelled by a pump .
When choosing the food administered, the specific nutritional needs of the patient must be taken into account. This concerns both the quantity (volume, number of calories, proteins, etc.) and the qualitative composition of the nutrients.
Distinguish between polymeric and semi-elemental preparations
- Polymer preparations are close to our traditional food , but in a liquid form that allows administration via a tube. This food still requires a functional intestine for digestion and absorption.
- Semi-elementary preparations consist of a number of nutrients that are close to the elementary building blocks of our food. They make few demands on the intestine in terms of digestion and absorption. Furthermore, the composition can respond to a disease state of the intestine (e.g. problems of inflammation, intolerance to certain molecules, specific enzymatic insufficiency).
Refund terms and conditions
The health insurance provides reimbursement for enteral nutrition for patients with one of the pathologies listed below.
- severe neurological pathologies with absence or incoordination of the swallowing reflex;
- sequelae of buccopharyngeal or laryngeal surgery and/or radiotherapy;
- obstruction of the oropharynx, esophagus, or stomach;
- hereditary metabolic diseases.
Patients with severe intestinal absorption disorders for whom parenteral nutrition is or was necessary because of:
- idiopathic inflammatory bowel diseases (Crohn's disease, ulcerative colitis) that:
- be drug resistant;
- and have affected extensive segments of the intestine;
- extensive intestinal resections;
- severe intestinal malabsorption due to:
- radioenteritis;
- total villous atrophy;
- intestinal lymphomas;
- chronic recurrent pancreatitis;
- cystic fibrosis;
- superinfection of the digestive tract in patients suffering from acquired immunodeficiency syndrome;
- persistent diarrhea in children, congenital or acquired;
- resistant chylous ascites.
Children and adolescents under 18 years of age with a serious condition resulting in malnutrition affecting the development of body height and body weight.
Patients suffering from a severe functional disorder of the gastrointestinal system with documented significant impact on nutritional status, where it was not possible to correct the nutritional status in an acceptable manner by oral route (via nasoduodenal tube or percutaneous jejunal tube). A detailed report with the history of the treatments must be drawn up by the specialist physician and attached to the application.
Patients suffering from a serious illness leading to severe malnutrition (either NRS Nutritional Risk Screening score greater than 3 or BMI less than 18.5) and not achieving recommended nutritional goals in the form of oral nutrition or oral nutritional supplements.
For this indication, enteral nutrition must be initiated during hospitalisation or during the three months following a hospital stay, on prescription from a physician who was responsible for treatment during the hospital stay.
The Royal Decree of 10 November 1996 emphasises the quality of the indication by referring to a team within the hospital that has extensive experience with tube feeding.
Amount
Multiple amounts can be combined per day .
- Depending on the type of food, one of the amounts below
- Use of a polymer product: 5.46 euros per day.
- Use of a semi-elemental product: 19.98 euros per day.
- Depending on the method of administration
- Without pump: material: 0.95 euros per day.
- With pump: material: 1.53 euros per day + use of the pump: 0.55 euros per day.
The patient must submit the receipts corresponding to the preparations and the means of administration to CM. The reimbursement can never exceed the amounts so justified.
Additional info
In addition to the Royal Decree of 10 November 1996, additional refunds are possible.
- If a stoma has been placed, the material (gastric button, catheter) will be reimbursed via the nomenclature of implants.
- Persons under the age of 19 enjoy an additional arrangement via the maximum invoice.
Art. 37sexies: "... The costs borne by the beneficiary, who has not reached the age of 19, with regard to enteral nutrition at home via a tube or stoma are also considered to be a personal contribution."
Procedure
The insurance reimbursement is determined by:
- the type of nutritional preparation;
- the method of administration : with or without pump.
The reimbursement depends on the approval of the consulting physician . This approval is valid for twelve months and can be extended each time for one year.
The treating physician-specialist can submit a request. This is done with a standard form that motivates the need for tube feeding.
Since February 1, 2025, the date on the invoice determines the refund.
