Standard electric breast pump (E0603): an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. Subscribe to Codify by AAPC and get the code details in a flash. None of the services are associated with co-payments.xv may perform any of the tests in its subgroups (e.g., 110, 120, etc.). <> The manual and electric breast pumps that are available commercially are not designed for reuse and are most commonly sold to mothers with normal infants who are working, traveling or for other reasons are not always home to breastfeed the baby. E0602 - Breast pump, manual, any type E0603 - Breast pump, electric (AC and/or DC), any type . The Ameda Purely Yours pump was discontinued by the manufacturer in late 2017. Access to this feature is available in the following products: Find-A-Code Essentials HCC Plus E0602 Breast pump, manual, any type. In the case of a birth resulting in multiple infants, only one breast pump is covered. Procedure code: E0603 (personal use double electric pump), E0602 (Hand pump), E0604 (Hospital-grade rental) *Most likely self-pay Contact the DME and request your breast pump and ask how to obtain it. represented by the procedure code. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. Hospital grade heavy duty electric breast pump (E0604) is available only when provided as a rental and must have a prior authorization. The terms of any applicable provider participation agreement; Routine claim editing logic, including but not limited to incidental or mutually exclusive logic; Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. Multiple Pricing Indicator Code Description. 30:4D-6o. No other changes made. anesthesia procedure services that reflects all Standard electric breast pumps or manual breast pumps may be appropriate to initiate breastfeeding in the postpartum period, within the first eight weeks following delivery. E0602/E0603 includes all necessary supplies and collection containers (kit). The DME provider is responsible for repairs or replacement during the one-year warranty. %PDF-1.5 The purchase of a standard electric breast pump (E0603) will be covered. BREAST PUMPS E0602/E0603 include all necessary supplies and collection containers (kit). anesthesia care, and monitering procedures. Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. Last Updated: March 27, 2022. r,WPwD'KRs(EUZ!%Q BY/i-4U`C+n/ju-bgJi4Vv=qe:mQb2b. E0602 Breast Pump, manual, any type E0603 Breast pump, electric (AC and/or DC), any type E0604 Breast pump, hospital grade, electric (AC and/or DC), any type Billing Guidelines: Member's medical records must document that services are medically necessary for the care provided. Interim review adding verbiage regarding the Ameda Mya Joy Plus pump. MDS67060 Double Electric Breast Pump 1/ea E0603 MDS67186 Manual Breast Pump 1/ea E0602 9 adjustable suction level Medline Industries, Inc. Three Lakes Drive, Northfield, IL 60093 | 1-800-MEDLINE (633-5463) . Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that do not have a prior authorization. (See notes below; this benefit is specific to nongrandfathered plan members only.). Providers must use procedure code E0602 or E0603 when billing for the purchase of a manual or non-hospital-grade electric breast pump. E0602 . (aWHd4'37S|  co@O'q('opT# Bci aj"U(^n5x6. Current recommendations from the American Academy of Pediatrics are to continue breastfeeding in infants through one year, A dual manual (E0602) or a standard, dual electric breast pump (E0603) is, for purchase for all women who choose to breastfeed. Cochrane Database Syst Rev. 7. Only one (1) hospital grade pump is allowed per birth event. is based on a calculation using base unit, time "Current Procedural TerminologyAmerican Medical Association. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross Blue Shield Association. Provide your insurance information. Horizon NJ Health shall consider for reimbursement one (1) breast pump supply kit per birth event. 1995; 126(2): 191-197. The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. Breast pump rental may be medically appropriate for infants while they are detained in the hospital. To ensure timely access, a breast pump should be ordered . Last Updated on Fri, 24 Feb 2017 | Human Lactation. <>>> endobj endobj Subscribe to Codify by AAPC and get the code details in a flash. #8 iU9X?v,\?c, All other providers, including retail or online vendors, are considered Out-of-Network and, For members who qualify for no cost sharing in relation to breast pump purchases, there are two allowable pumps available -- the Ameda Purely Yours electric pump and the Ameda One Hand manual pump, Interim review to add coverage for A4283-A4286 and K1005 effective 01/01/2023. administration of fluids and/or blood incident to <>>> Continued rental of a hospital-grade electric pump is considered NOT MEDICALLY NECESSARY once the baby has been discharged. Breast-feeding of very low birth weight infants. Interim review indicating that Ameda is phasing out the Finesse model and replacing it with the Mya model. Annual review, no change to policy intent. Number identifying the processing note contained in Appendix A of the HCPCS manual. Timer to track breast pumping sessions. This policy provides reimbursement guidelines for breast pumps, breast pump supplies and lactation counseling. We verify your coverage and submit all required paperwork on your behalf. % It has been replaced by the Ameda Finesse pump, and this replacement model will be considered allowable for the no cost sharing breast pump purchases. E0603* Purchase of a personal-use, electric breast . Effective January 1, 2016, Prevea360 Health Plan covers at 100% the purchase of one manual breast pump or one personal-use electric breast pump per birth. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. The purchase of a standard electric breast pump (E0603) will be covered. Anderson JS, Johnstone Bm, Remley DT. No prior approval needed. NOTE:The Medela In-Style pump has been updated to Medela Pump in Style with Maxflow for 2022. Web If you choose a different breast pump or get one through a different provider it may be subject to cost sharing such as deductibles copays or coinsurance. . 8. fee under another provision of Medicare, or to no 1 0 obj E0603, E0604: In lieu of an electric breast pump, purchase of a manual breast pump is eligible for reimbursement when one of the above criteria is met. The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases.. E0602 - manual breast pump E0603 - electric breast pump . Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). Cochrane Database Syst Rev. The following breast pump replacement parts are limited to no more than two of each per year: A4281- Replacement breast pump tube . The carrier assigned CMS type of service which As of 2013, this field contains the consumer friendly descriptions for the AMA CPT codes. tables on the mainframe or CMS website to get the dollar amounts. You may be required to fax or send the prescription if the breast pump will be shipped directly to your home. All Rights Reserved". . All parts must be submitted with modifier U8. 4 0 obj Notwithstanding the foregoing, all payment determinations are subject to all other, applicable limitations, including but not limited to, the following: CPT Copyright 2017 American Medical Association. .aH?HQ*Qe Ja\\%r0&RIZ! CPT Codes / HCPCS Codes / ICD-9 Codes HCPCS codes covered if selection criteria are met:: A4281 - A4286 Breast pump supplies [for rented reusable breast pump pumps only] E0602 Breast pump, manual, any type [rented reusable only] E0603 Breast pump, electric (AC and/or DC), any type [rented reusable only] E0604 Breast pump, hospital grade . A4284 - Replacement Breast Pump Shield A4285 - Replacement Breast Pump Bottle A4286 - Replacement Breast Pump Lock Ring A9900 - Misc Code Mom Baby Baby (continued) Created Date: 5/30/2018 12:55:02 PM . BREAST PUMP - E0603NU (ELECTRIC . xFtW0H(\_1B?2X<>&Ei/v7IMNbH|U!N0/AaZnZyEiTx5~M L$ijE@Z+ZjQ[1^%B/]%JeqI3W?a%deU_'TfKlc2J+*# 14+74wC638I(7w?z@cG/=dz Request a Demo 14 Day Free Trial Buy Now Official Long Descriptor Breast pump, manual, any type Crosswalks HCPCS MODIFIERS performed in an ambulatory surgical center. E0602 - manual breast pump . E0603. Request a Demo 14 Day Free . % E0604, heavy-duty hospital grade electric breast pumps are rental . 8TpVd2W){?~-n{cd4,*Ox A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. 4.2.3 For dates of service prior to July 5, 2018, standard power adapters, tubing and tubing adaptors, locking rings, bottles, bottle caps, shield/splash protectors, and storage bags used with the breast pump are covered as necessary for up to . Dewey KG, Heninig MJ, Nommsen-Rivers LA. Bill with modifier NU. All other providers, including retail or online vendors, are considered out of network. Limits. (28 characters or less). Copyright 2007-2022 HIPAASPACE. ), Rental of a heavy-duty, hospital-grade electric breast pump (E0604) and purchase of necessary supplies, during the time a mother and infant are separated because the infant. The 'YY' indicator represents that this procedure is approved to be For premature infants, breast milk may assist in preventing infections, speeding recovery from respiratory distress syndrome, increasing weight gain, protecting against retinopathy, and facilitating cognitive and visual development. Breast-feeding and cognitive development; a meta-analysis. to the specialty certification categories listed by CMS. Rental or purchase of hospital grade breast pumps is not covered. !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D The purchase of a breast pump is limited to one every three years. Manual breast pumps of any type, including pedal powered, are covered under HCPCS procedure code E0602. Code used to classify laboratory procedures according Breast Pumps: Horizon NJ Health will consider for reimbursement either one (1) purchased manual breast pump (HCPCS code E0602) OR one (1) purchased electric breast pump (HCPCS code E0603) per birth event. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. NOTE:For members who qualify for no cost sharing in relation to breast pump purchases, there are two allowable pumps available:the Ameda Purely Yours electric pump and the Ameda One Hand manual pump. Or, if you would like to remain in the current site, click Cancel. e0602 The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. 45 products found for " E0603 ." Manufacturer ARDO MEDICAL INC. Ameda/Evenflo Drive Medical Freemie Hygeia Kinray-Cardinal Health Lansinoh Medela Motif Medical Roscoe Medical Spectra Baby USA Unimom. Standard member benefits provide coverage for only one (1) manual (E0602) or electric (E0603) breast pump purchase per delivery. The process involves nipple stimulation with use of an electric breast pump beginning about two months before the adoptive mother expects to begin breast-feeding. The purchase of an electric breast pump is limited to one every three years. J Pediatr. Choose from the curated breast pumps, maternity support and postpartum recovery items covered by your insurance. HCPCS Code Description: Breast pump, electric (ac and/or dc), any type Breast pumps* and replacement parts are covered for all KanCare female beneficiaries ages 12 through 55. Breast Pumps E0602, E0603 Frequency: 1x/pregnancy Ages: All Breast Pump Supplies A4281, A4282, A4283, A4284, A4285, A4286 Breast MRI* CT Mandate 77046, 77047, 77048, Includes breast pump, comfortable silicone insert, nipple with collar, pump cap, bottle, bottle cap, bottle stand, bottle adaptor and . Subscribe to Codify by AAPC and get the code details in a flash. levels, or groups, as described Below: Short descriptive text of procedure or modifier code How to order breast pumps at UCLA E0604 - Hospital Grade Breast Pump Find your care If you are a new patient seeking prenatal care, please call 310-794-7274. J Pediatr. The physician orders or recommends the following breast pump for use by the member: Breast pump, manual, any type(E0602) - Purchase . Description: Breast pump, manual, any type: BETOS Code: D1E - Other DME: Action Code: N - No maintenance for this code: Type of Service Code: 9 - Other medical items or services: Pricing Indicator Code: 32 - Inexpensive & routinely purchased DME (price subject to floors and ceilings) 4.2.2 One manual (E0602) or one standard electric (E0603) breast pump may be covered per birth event. _L5am#`0,5y4,.+O} @{)6L'TV8u]WR,HP"rQQZ`{%66U@0)XLEK~eU,UiqGWu y74szmMq t}Ix). describes the particular kind(s) of service lnq.'$scXkUY?(%[*n_\ a[Zd]^L 0Z]8S.BHdbmC~mUM 96piVS.KZaKP pw*5hZnbo:l{(, 1993; 123(5): 773-778. The date the procedure is assigned to the Medicare outpatient group (MOG) payment group. This field is valid beginning with 2003 data. E0603 HCPCS Code for Breast pump, manual, any type E0602 HCPCS code E0602 for Breast pump, manual, any type as maintained by CMS falls under Breast Pumps . This material is the confidential, proprietary and trade secret product of BlueCross BlueShield of South Carolina. Verbiage added about billing a hands-free single-use pump. American Medical Association, Current Procedural Terminology (CPT) and associated publications and services. 2 0 obj Number identifying the reference section of the coverage issues manual. ?xweh 98=#a4a"OL8`YTeQME2wCYt=Fs0(=^}/H^z->.:(rmr$?}f93@l!Xq*'N~_n}2a=y%{>L$a\raE&a2 C4q6\@vs/ 32U~t"2R$KnbD`H$a,AQJ'C]Ow(\Cv2tW =z4!A$} C7o%\SW`L=$WdNLFyqj|%P)"?3$LM#eMVw>?KB9>)ku_wY9e|R0YVxY?+AKAoz6S bn?`4=>9ugvH0u|O?AH^.C$Gk)EzC)5 HCPCS Code: E0603. Under procedure code E0603, Wisconsin Medicaid now requires that electric breast pumps meet the following specifications: The pump must utilize suction and rhythm equivalent to the hospital . Prior authorization is required for circumstances beyond the standards of coverage and payment rules. HCPCS Code E0602 - Manual breast pump. Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with . Any unauthorized use, reproduction or transfer of these materials is strictly prohibited. E0602 Breast pump, manual, any type. (Note: the payment amount for anesthesia services Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. O09.40, O09.41, O09.42, O09.43, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.70, O09.71, O09.72, O09.73, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93, O36.80X0, O36.80X1, O36.80X2, O36.80X3, O36.80X4, O36.80X5, O36.80X9, O91.011, O91.012, O91.013, O91.019, O91.02, O91.03, O91.11, O91.111, O91.112, O91.113, O91.119, O91.12, O91.13, O91.2, O91.21, O91.211, O91.212, O91.213, O91.219, O91.22, O91.23, O92.011, O92.012, O92.013, O92.019, O92.02, O92.03, O92.111, O92.112, O92.113, O92.119, O92.12, O92.13, O92.20, O92.29, O92.3, O92.4, O92.5, O92.6, O92.70, O92.79, P92.5, Z13.0, Z33.1, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z39.0, Z39.1 or Z39.2. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. E0602* Purchase of a personal-use, manual breast pump. A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. (November 2021). The first breast pump patent was filed by Orwell H Durable Medical Equipment (DME) E0602 is a valid 2022 HCPCS code for Breast pump, manual, any type or just " Manual breast pump " for short, used in Other medical items or services E0603 Breast pump, electric (AC and/or DC), any type Quick view Quick view Quick view E0602 Manual Breast Pump . Note: Medical records must support the need for a hospital grade pump. stream Procedure Codes A4281 A4282 A4283 A4284 A4285 A4286 Description: A breast pump is a mechanical device used to extract milk from a lactating mother. Updating policy to include information regarding no cost share pumps allowed. <> HCPCS Code for Breast pump, electric (AC and/or DC), any type E0603 HCPCS code E0603 for Breast pump, electric (AC and/or DC), any type as maintained by CMS falls under Breast Pumps . Contains all text of procedure or modifier long descriptions. In-person lactation counseling and lactation consultation will be considered for reimbursement by non-physician providers using HCPCS code S9443 (Lactation classes, non-physician provider, per session). E0602. collection of codes that represent procedures, supplies, What is a breast pump's CPT code? Access to this feature is available in the following products: E0603 - Breast Pump, Electric CareSource will allow E0603 (Electric Breast Pump) for purchase if one of the below needs are indicated: Infant illness (specify)_____ Difficulty with "latch on" due to physical, emotional, or developmental problems of mother or infant (specify) . E0602 Breast pump, manual, any type one E0603 #Breast pump, electric (AC and/or DC), any type one CPT is a registered trademark of the American Medical Association. Can be used for single or double pumping - Dual Accessory Kit Includes: 1 Pair Tubing. Rental of a heavy-duty, hospital-grade electric breast pump (E0604) and purchase of necessary supplies is MEDICALLY APPROPRIATE during the time a mother and infant are separated because the infant remains hospitalized upon the mother's discharge. The hospital grade electric breast pump is still being utilized by the mother. All other providers, including retail or online vendors, are considered Out-of-Network and For members who qualify for no cost sharing in relation to breast pump purchases, there are two allowable pumps available -- the Ameda Purely Yours electric pump and the Ameda One Hand manual pump. Supplies necessary for use of a breast pump, such as tubing (A4281) and adapter (A4282), are MEDICALLY APPROPRIATE and covered as necessary. 2022 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. No other changes made. Jr8XcYL c,:Sc:,L$3P(=VP6G%b(8] 5bh*2_)\7(U1v,7NJ.*j0F;4CYTsTP&y#&$S.Z4)G~F\ J6{k^8mmUj3 v0um:j=/W*pf#E A"e,eUn 1yEIA;^h% 3 0 obj E0602 Breast pump, manual, any type the Division will purchase; . x[o ~ NrZ~)&*K>"\"-c}{mv~=9~Y A procedure Berenson-Eggers Type Of Service Code Description. Interim review to update note regarding brands of pump available to include the Medela In-style pump beginning in February 2020. XY$#+hi`A2~|>bM|^?TR" C8hyp>, valid current code (or range of codes). 2 storage bag adapters and 10 storage bags. The goal of the hospital grade pump is to . This means it must have an . These are covered but no t more than one total per year . Breast pump rental may be medically appropriate for infants while they are detained in the hospital. E Codes E0603 HCPCS Code E0603 - Electric breast pump HCPCS Long Description: Contains all text of procedure or modifier long descriptions. E0603 Breast pump, electric (ac and/or dc), any type HCPCS Procedure & Supply Codes E0603 - Breast pump, electric (ac and/or dc), any type The above description is abbreviated. remains hospitalized upon the mother's discharge. Online: www.tricare-west.com . Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with modifier -SC. All Rights Reserved. American Academy of Pediatrics (AAP). Supplies necessary for use of a breast pump, such as tubing (A4281) and adapter (A4282), Replacement supplies primarily for comfort and convenience (A4283, A4284, A4285 and A4286), and milk storage products are not covered, as they are, Effective Jan. 1, 2023 A4283, A4284, A4285, A4286 and K1005 will be considered, All other providers, including retail or online vendors, are considered out of network, For members who qualify for no cost sharing in relation to breast pump purchases, there are two allowable pumps available:the Ameda Purely Yours electric pump and the Ameda One Hand manual pump. Replacement breast pump supplies (A4281-A4286) are not separately reimbursable on the same date of . However, rental of a hospital-grade, heavy-duty electrical breast pump requires prior authorization through the Medical Affairs Division. Subscribe to Codify by AAPC and get the code details in a flash. }`BZJ~?"pFrF}/>7R .|0smsY< HCiW,B\]_ZW+-U3_WI_j(2 Iwc.j'ts^XA units, and the conversion factor.). CPT Code(s): A4281-A4286, E0602-E0604. Pickering LK, Baker CJ, Long SS, McMillan JA, Eds. Search Results. Copyright {{ Breast Cancer Screening Breast/ mammo-gram B "77063, 77067, " Z80.3, Z12.39, Z12.31 USPSTF recommends interven-tions during pregnancy and after birth to promote and support breastfeeding breastfeed-ing B 99211, S9443 Z39.1 Breast Pumps Breast pump E0602, E0603 1 manual pump OR 1 electric pump per lifetime Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. This item is available for rental only. Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. What is the breast pump's HCPC code? The Ameda Purely Yours pump was discontinued by the manufacturer in late. usual preoperative and post-operative visits, the Manual Breast Pump purchase, CPT Code E0602 Hospital Grade Electric Breast Pump rental, CPT Code E0604 Individual Electric Breast Pump purchase, CPT Code E0603 Example of a State Benefit Package Rhode Island provides the following benefit package for breastfeeding mothers enrolled in Medicaid. Information about E0602 HCPCS code exists in. All rights reserved. Horizon NJ Health will cover certain breastfeeding equipment and services consistent with the New Jersey Breastfeeding Support Law at N.J.S.A. HCPCS Code Description. stream activities except time. NOTE: The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. (t_L7{{qSBk'MjgwSM Adjustable speed and suction settings for maximum comfort and efficiency. Breast pump, electric (AC andor DC), any type/ (E0603) - Purchase . A code denoting the change made to a procedure or modifier code within the HCPCS system. 2007; (4): CD002971, Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. Name - Physician: 9. Kramer MS, Kakuma R. Optimal duration of exclusive breast-feeding. Digital controls, LCD screen and nightlight. Horizon NJ Health will only consider a hospital grade pump (HCPCS code E0604) with a prior authorization and if the pump is a rental unit appended with modifier RR. All types of electric breast pumps, AC or DC, are covered under procedure code E0603, that meet the following specifications: The pump must utilize suction and rhythm equivalent to the hospital-grade breast pump. Code used to identify instances where a procedure <> J pediatr. Last date for which a procedure or modifier code may be used by Medicare providers. The Berenson-Eggers Type of Service (BETOS) for the beneficiaries and to individuals enrolled in private health This benefit does not require prior authorization. 1995; 126(5 Pt 1): 696-702. 2006. . new Date().getFullYear() }} BlueCross BlueShield of South Carolina. Horizon NJ Health will not consider for reimbursement breast pumps, breast pump supplies or lactation counseling when the code is not billed with one of the diagnosis codes outlined in this policy. could be priced under multiple methodologies. Manual breast pump (E0602):a non-electric pump that works by vacuum suction generated through biomechanical effort. Choose from the curated breast pumps, maternity compression and postpartum recovery items covered by . Procedure Codes E0603 E0604 In lieu of an electric breast pump, purchase of a manual breast pump is eligible for benefits when one of the above criteria is met. The manual and electric breast pumps that are available commercially are not designed for reuse and are most commonly sold to mothers with normal infants who are working, traveling or for other reasons are not always home to breastfeed the baby. Interim review, adding the following verbiage to the policy: (See notes below, this benefit is specific to non-grandfathered plan members only). This includes but is not limited to prematurity, neonatal or maternal illness, neurological abnormalities, and anatomic abnormalities such as oro-facial or breast anomalies. These activities include New Jersey Breastfeeding Support Law, N.J.S.A. E0604 Breast pump - heavy duty hospital grade. E0602 Breast pump, manual, any type E0603 Breast pump, electric (AC and/or DC), any type E0604 Breast pump, hospital grade, electric (AC and /or DC), any type V. Annual Review History Review Date Revisions Effective Date 09/25/2019 New criteria 01/01/2020 09/23/2020 Annual Review: No changes 10/01/2020 Members are entitled to one breast pump in a 12-month period. Rental of hospital grade breast pumps is limited to Durable Medical Equipment vendors. There are three basic types: Background: Breastfed infants have a lower risk of diarrhea and otitis media than bottle-fed infants during the first year of life. Please click Continue to leave this website. Are you sure you want to leave this website? Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. Human milk. E0604. Telephonic lactation assistance will be considered for reimbursement using CPT codes 99441 (Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion), 99442 (Telephone evaluation and management service by a physician or other qualified health care professional, 11-20 minutes of medical discussion) and 99443 (Telephone evaluation and management service by a physician or other qualified health care professional, 21-30 minutes of medical discussion). Additional Specs. endobj Description of HCPCS Lab Certification Code #1, Description of HCPCS Lab Certification Code #2, Description of HCPCS Lab Certification Code #3, Description of HCPCS Lab Certification Code #4, Description of HCPCS Lab Certification Code #5, Description of HCPCS Lab Certification Code #6, Description of HCPCS Lab Certification Code #7, Description of HCPCS Lab Certification Code #8. My Account; EN; ES; 0 Items Long Description for E0602: BREAST PUMP, MANUAL, ANY TYPE PDF Breast Pump E0603nu (Electric Ac/Dc, Any Type); E0602nu (Manual, Any In the case of a birth resulting in multiple infants, only one (1) breast pump is covered BREAST PUMPS E0602/E0603 include all necessary supplies and . HCPCS: E0602 Log in to see pricing Sold by: Each Ameda Elite Hospital Grade Breast Pump with Cord, 30 to 250 mmHg, 30 to 60 cpm Cycles EW17608 Ameda/Evenflo HCPCS: E0604 Log in to see pricing Sold by: Each Ameda One-Hand Breast Pump, Sterile, BPA and DEHP Free EW17161 Ameda/Evenflo HCPCS: E0602 Log in to see pricing Sold by: Each Replacement supplies primarily for comfort and convenience (A4283, A4284, A4285 and A4286) and milk storage products are not covered, as they are NOT MEDICALLY NECESSARY. . Breast Pumps E0602, E0603 Frequency: 1x/pregnancy Ages: All Breast Pump Supplies A4281, A4282, A4283, Each part - up to 2 times within 12 months from the breast pump date of purchase. [F=3f9C{rkHoe$@'2FZ)U=zmzmGTS?56A9m\4PKd-q'utD*1]o`:bJQwC6z )?t jONwE] %PDF-1.5 to payment of an ASC facility fee, to a separate Standard electric breast pumps or manual breast pumps may be appropriate to initiate breastfeeding in the postpartum period, within the first eight weeks following delivery. You must access the ASC Manual and electric breast pumps (E0602 and E0603) are available with a prescription to our members* through EmblemHealth participating durable medical equipment (DME) vendors.

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