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24.2.2 Benefits, Limitations, and Authorization Requirements
The CSHCN Services Program may cover medical foods for clients with inborn errors of metabolism that prohibit them from eating a regular diet.
Medical foods are defined as:
• Lacking in the compounds which cause complications of the metabolic disorder.
•Not generally available in grocery stores, health food stores, or pharmacies.
•Not used as food by the general population.
•Not foods covered under the Food Stamps program.
•Approved products listed in enrolled provider's catalogs.
The CSHCN Services Program only pays for foods with nutritional value.
Providers must use procedure codes S9434 and S9435 when submitting claims for medical foods.
Foods with minimal nutritional value, including but not limited to the following, are not a benefit of the CSHCN Services Program:
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