Are enteral and parenteral feeding systems — nasogastric/gastrostomy tubes and related supplies — exempt from Texas sales tax as prosthetic devices, and what about the liquid food delivered through them?

Plain-English summary

Someone asked about the taxability of enteral feedings and the supplies/equipment needed to administer them. The Comptroller confirmed that nasogastric and gastrointestinal (enteral and parenteral) devices and their related supplies form "systems" that qualify as exempt prosthetic devices — exempt whether or not sold with a doctor's prescription.

The reasoning ties back to 34 TAC Rule 3.284's core definition: a prosthetic device is "acting as a replacement for [a] vital organ which is inoperative or damaged in some manner." An enteral/parenteral feeding system replaces the normal digestive intake function, so it (and specifically-designed replacement parts) qualifies as exempt when used to replace a missing, damaged, or non-functioning vital organ or bodily function.

Two important limits on the exemption's scope:

1. Only items that directly become part of the system qualify. The same type of supply or equipment might be used for other purposes or as part of a different system that doesn't qualify as a prosthetic device — so being the "same kind of item" isn't enough; it has to actually function as part of the feeding system.
2. Exemption certificates need to be specific. Because the exemption is restricted this way, the certificate provided when buying these items must state the exact reason for the exemption, rather than a general reference to Rule 3.284.

Separately, the liquid food delivered to the patient through the feeding system is exempt too — as a food product, independent of the prosthetic-device analysis for the delivery hardware.

What this means for you

Medical supply companies selling enteral/parenteral feeding equipment

Nasogastric, gastrostomy, and related feeding tube systems and their directly-related supplies qualify as exempt prosthetic devices, with or without a prescription. But be precise on exemption certificates — state the specific reason the item qualifies (its role in the feeding system) rather than a blanket Rule 3.284 citation, since the same product type can be taxable in a different use context.

Hospitals, home health providers, and patients

Enteral/parenteral feeding systems and the liquid nutritional food delivered through them are both exempt from Texas sales tax.

Accountants and tax professionals

This letter is a useful example of the Rule 3.284 "replacement of an inoperative/damaged vital organ" test applied to a nutritional-delivery system, plus a caution about exemption certificate specificity for multi-use supply types — a generic Rule 3.284 reference isn't sufficient because the same item can fall in or out of the prosthetic-device category depending on its actual use.

Common questions

Q: Are feeding tube systems (nasogastric, gastrostomy) exempt from Texas sales tax?
A: Yes, they qualify as prosthetic devices under 34 TAC Rule 3.284, exempt whether or not sold with a doctor's prescription.

Q: Is the liquid nutritional food delivered through the system also exempt?
A: Yes, separately, as a food product.

Q: Does every supply that could be used in a feeding system automatically qualify for the exemption?
A: No. Only supplies and equipment directly related to and that become part of the enteral/parenteral system qualify — the same type of product used for other purposes or different systems may not qualify.

Q: What should an exemption certificate for these items say?
A: The exact reason for the exemption (the item's specific role in the feeding system), not just a general reference to Rule 3.284.

Q: Can I rely on this letter for my own medical supply products?
A: No. This opinion is based on the facts submitted and current law; other facts, though similar, may result in different answers.

Citations and references

Rules:

• 34 TAC Rule 3.284 (Drugs, Medicines, Medical Equipment, and Devices — prosthetic device definition)

Source

• STAR search: https://star.comptroller.texas.gov/search?doc_type_code=L&tax_type_code=SST
• Opinion: https://star.comptroller.texas.gov/view/200004244L

Original ruling text

April 28, 2000

Dear **:

Thank you for your recent letter concerning the taxability of enteral feedings
and the supplies and equipment necessary to administer such feedings.

Nasal gastric and gastrointestinal (enteral and parenteral) devices and related
supplies are "systems" that qualify as prosthetic devices. These systems are
exempt from tax when sold with or without a doctor's prescription.

It is important to note that supplies and equipment are exempt only when
directly related to and become a part of the enteral and parenteral "system."
It may be possible that these same type(s) of products can be used for other
purposes or as parts of other systems that do not qualify as prosthetic
devices. Because of the restricted nature of this exemption, the exemption
certificate provided on the purchase of these items or "systems" must state the
exact reason for the exemption, rather than the general reference to Rule
3.284.

In Rule 3.284, "...the definition of a prosthetic device must be read with the
basic understanding that the device is acting as a replacement for the vital
organ which is inoperative or damaged in some manner."

The products or "system" including replacement parts designed specifically for
such devices and appliances are considered exempt as prosthetic devices only
when they are used to replace missing, damaged, or non-functioning vital organs
or appendages of the human body.

The liquid food that the patient receives through the "system" is exempt a food
product.

The State Tax Automated Research (STAR) system, which provides viewing and
downloading of our rules, the Tax code, edited letter rulings, hearings,
Attorney General Opinions, etc., may be accessed on the Internet at:
http://www.window.state.tx.us/

This opinion is based on the facts you submitted and current law. Other facts
though similar, may result in different answers.

If you have any questions or need more information, I'll be glad to help you.
Please call me toll free at 1-800-531-5441, extension 5-0330. My direct line is
512/475-0330. My email address is .

Sincerely,

Bettie Peterson
Tax Policy Division