PATIENT ASSISTANCE PPROGRAMS

Assistance Programs

Reimbursement

Many state Medicaid programs and private payors will consider coverage of PediaSmart® for children when specific medical criteria is met. Nature's One® products have been assigned HCPCS codes by the Center for Medicare & Medicaid Services. Natures One® does not accept Medicare, Medicaid or private insurance directly. Instead, our products can be purchased through DME supply companies and pharmacies.

The HCPCS codes and NDC format codes are used for billing and reimbursement purposes. For coverage information, please direct questions to your state Medicaid office. Nature's One® has created a certificate of medical necessity for your convenience. This form includes nutritional information typically requested by private payers for review purposes. Please contact your insurance company directly as they may require additional information.

WIC Eligibility

Each WIC State agency determines its own allowed formula list. This database is a national listing of eligible products. Contact your state WIC office to determine the availability of PediaSmart® in your area.

http://wicworks.nal.usda.gov/nal_web/wicworks/formulas/FormulaSearch.php.

Medical Hardship Discount Program

For patients who do not qualify for Medicare/Medicaid or private insurance coverage, Nature's One® offers a significant discount for children with serious medical conditions. The enrollment process requires doctor recommendation and application approval by Nature's One®.

Patients with medical conditions currently enrolled through this program include: Cancer, Celiac Disease, Cerebral Palsy, Eating Disorders, Cystic Fibrosis, Down Syndrome, Malabsorption Syndromes and Metabolic Disorders.

To enroll, go to Medical Hardship

HCPCS & NDC Format Codes* Nature's One® Products Calories per Can
HCPCS: B4158
NDC: 16514-0229-00
Baby's Only Organic®
Dairy Toddler Formula
1680 Calories
HCPCS: B4158
NDC: 16514-2290-27
Baby's Only Organic®
Dairy with DHA& ARA Toddler Formula
1680 Calories
HCPCS: B4158
NDC: 16514-0229-03
Baby's Only Organic®
Lactose Free Toddler Formula
1680 Calories
HCPCS: B4159
NDC: 16514-0539-50
Baby's Only Organic®
Soy Toddler Formula
1680 Calories
HCPCS: B4160
NDC: 16514-0882-01
PediaSmart® Organic Dairy
Nutritional Supplement (chocolate)
1680 Calories
HCPCS: B4160
NDC: 16514-0881-01
PediaSmart® Organic Dairy
Nutritional Supplement (vanilla)
1680 Calories
HCPCS: B4160
NDC: 16514-0881-03
PediaSmart® Organic Soy
Nutritional Supplement (vanilla)
1680 Calories
HCPCS: B4103
NDC: NA
PediaVance® Electrolyte
Oral Maintenance Solution
N/A

*NDC Format Code Source: First Databank & Red Book


For questions regarding coverage, please contact your state Medicaid office or private insurance company. For Medicaid State by State Description and Plans, click on the following link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html.