Prevalence of Home Parenteral and Enteral Nutrition in the United States

Manpreet S. Mundi, Adele Pattinson, Megan T. McMahon, Jacob Davidson, Ryan T. Hurt

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Background: Malnutrition is highly prevalent and associated with increased morbidity and mortality. Studies continue to reveal significant clinical benefits with nutrition support, including improved wound healing, reduction in complications and length of stay, and mortality. Due to these benefits, the prevalence of home parenteral and enteral nutrition (HPEN) continues to increase worldwide. In the United States, given our healthcare insurance landscape, it has been very difficult to ascertain the true prevalence of HPEN. Methods: Medicare beneficiary data for 2013 were obtained from Centers for Medicare and Medicaid Services. Commonly used Healthcare Common Procedure Coding System codes were used for home enteral nutrition (HEN) and home parenteral nutrition (HPN). Data regarding number of patients and insurance providers were also obtained from 3 of the largest home infusion providers in the United States (Coram CVS, Option Care Enterprises, and BioScrip Inc). Based on the ratio of Medicare to non-Medicare billing, an estimate of HPEN prevalence was obtained. Results: For 2013, there were 6778 Medicare beneficiaries for HPN and 114,287 for HEN. The ratio of Medicare to non-Medicare was 0.271 for HPN and 0.261 for HEN, leading to an estimated prevalence of 25,011 patients receiving HPN (79 per million U.S. inhabitants) and 437,882 patients receiving HEN (1385 per million U.S. inhabitants). There are an estimated 4129 pediatric patients and 20,883 adult patients receiving HPN; for HEN, 189,036 pediatric patients and 248,846 adult patients. Conclusion: Compared with results from 1992, the prevalence of HEN has increased dramatically, while the prevalence of HPN has declined.

Original languageEnglish (US)
Pages (from-to)799-805
Number of pages7
JournalNutrition in Clinical Practice
Issue number6
StatePublished - Dec 1 2017


  • enteral nutrition
  • health insurance reimbursement
  • home care agencies
  • home care services
  • home nutritional support
  • long-term care
  • parenteral nutrition
  • reimbursement

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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