Amino Acid-Based Elemental Formula Sample Clauses

Amino Acid-Based Elemental Formula. Benefits will be provided for Medically Necessary amino acid-based elemental formula, regardless of the delivery method, for the diagnosis and treatment of: A. Immunoglobulin E and Non-Immunoglobulin E mediated allergies to multiple food proteins; B. Severe food protein induced enterocolitis syndrome; X. Xxxxxxxxxxxx disorders, as evidenced by the results of a biopsy; and D. Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length and motility of the gastrointestinal tract.
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