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Malnutrition Policy Revision Policy: Effective September 1, 2026

Date: 07/07/26

Thank you for your continued partnership with Sunflower Health Plan. As you know, we continually review and update our payment and utilization policies to ensure that they comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of the revision to existing policies Sunflower will be implementing effectively with dates of service starting September 1, 2026. Posted policy on site contains a revision log explaining the updates that occurred in the annual review.

Lines of Business: Medicare, Marketplace, Commercial

Policy Number: CP.PP.145

Policy Name: Malnutrition

Policy Description: Acute care hospitalizations for malnutrition require the most appropriate and most specific level of diagnosis coding. The medical record documentation supporting the diagnosis should be clearly documented by the physician or a licensed independent practitioner.

The cost difference between a Diagnosis Related Group (DRG) billed with malnutrition as a major complication or comorbidity (MCC) (in a position other than as the primary diagnosis code position) and a DRG billed without malnutrition as an MCC (in a position other than as the primary diagnosis code position) will be denied reimbursement unless meeting the documentation requirements described in this policy.

The purpose of this policy is to support a retrospective review of inpatient claims billed with the diagnosis of malnutrition.

Changes to reviews include:

Updated Criteria I. to include non-severe (moderate) malnutrition diagnosis criteria guidelines and treatment. Added Criteria II. to include severe malnutrition diagnosis criteria guidelines and treatment. Coding and descriptions reviewed. Added ICD-10 codes E44.0 and E44.1.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the numbers below:

 

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