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A permanently or severely impaired swallowing mechanism, or a demonstrated inability to safely ingest oral nutrition A physician’s determination that enteral nutrition is medically necessary and expected to persist for at least 90 days A nutritional assessment documenting that oral intake cannot meet the patient’s caloric and protein needs A diagnosis directly causing the nutritional impairment (supported by a covered ICD-10 code per CMS policy article A58833) Documentation that the enteral formula is administered via feeding tube, not consumed orally The swallowing-impairment criterion is often first found in a speech therapy practice assessing the patient, before the referring physician orders enteral feeding

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Vitamin B12 deficiency, left untreated, can lead to pernicious anaemia or neurological problems