S9435 Medical foods for inborn err

Medical foods for inborn errors of metabolism

Medicare pricing for S9435

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S9435

2 of 2 payer prior-auth lists that name S9435 require prior authorization or set conditions: Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Rocky Mountain Health PlansRocky Mountain Health Plans CHP+COprior auth requiredOct 1, 2026Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth under conditionsCost over $500Jul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name S9435

S9435 appears in 17 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaNutritional Support (0061)listed, no stanceJan 15, 2026payer document
AnthemHome Enteral Nutrition (CG-MED-08)covered if criteria are metAug 13, 2026payer document
Blue Cross & Blue Shield of Rhode IslandOral Nutrition Mandate sadcovered if criteria are metFeb 4, 2026payer document
CignaInfant Nutritional Formula (0136)covered if criteria are metSep 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Nutritional Support (MED201.011)
HCPCS Codes B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4102,		listed, no stanceJan 1, 2026payer document
Premera Blue CrossHome Nutritional Support
Page | 5 of 19 | ∞		listed, no stanceMay 1, 2026payer document
RegenceEnteral and Oral Nutrition Therapy in the Home Setting (Allied Health 05)listed, no stanceMar 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (MP.027.14)
Metabolic and Specialized Foods		listed, no stanceMay 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (CS136.R)
Metabolic and Specialized Foods		listed, no stanceMay 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Idaho Only) (CS136ID.D)
Metabolic and Specialized Foods		listed, no stanceJul 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Kansas Only) (CS136KS.03)
Metabolic and Specialized Foods		listed, no stanceMay 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Kentucky Only) (CS136KY.13)
Metabolic and Specialized Foods		listed, no stanceMay 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Nebraska Only) (CS136NE.O)
Metabolic and Specialized Foods		listed, no stanceJun 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for New Mexico Only) (CS136NM.D)
Metabolic and Specialized Foods		listed, no stanceMay 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Ohio Only) (CS136OH.F)
Metabolic and Specialized Foods		listed, no stanceJun 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Pennsylvania Only) (CS136PA.R)
Metabolic and Specialized Foods		listed, no stanceAug 1, 2026payer document
UnitedHealthcareEnteral Nutrition (Oral and Tube Feeding) (for Tennessee Only) (CS136TN.P)
Metabolic and Specialized Foods		listed, no stanceJun 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IL, IN, KY, ND, OH.

  • IL: $250.00 (dme), effective Jan 1, 2026
  • IN: $6.09 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.