The Mya model will now be considered allowable for the no cost sharing breast pump purchases. usual preoperative and post-operative visits, the Level II Codes E0602 - E0604, A4281 - A4286, A9900, A9999 3.0 Background 3.1 Effective August 8, 2005, TRICARE began covering heavy-duty hospital grade breast pumps and associated supplies for mothers of premature infants. The purchase of a personal-use electric breast pump (HCPCS code E0603). 7. There are currently 3 types of breast pumps that are "coded" by insurance companies, different health plans provide coverage for one or more of these types of pumps: 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 The purchase of a standard electric breast pump (E0603) will be covered. Manual and electric breast pumps (E0602 and E0603) are available with a prescription to our members* through EmblemHealth participating durable medical equipment (DME) vendors. (Note: the payment amount for anesthesia services Request a Demo 14 Day Free Trial Buy Now lnq.'$scXkUY?(%[*n_\ a[Zd]^L 0Z]8S.BHdbmC~mUM 96piVS.KZaKP pw*5hZnbo:l{(, The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. BREAST PUMP - E0603NU (ELECTRIC . Annual review, no change to policy intent. Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). It has been replaced by the Ameda Finesse pump, and this replacement model will be considered allowable for the no cost sharing breast pump purchases. 1995; 126(2): 191-197. Last Updated: March 27, 2022. Harvard What is a breast pump's CPT code? J Pediatr. 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% !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D Search Results. 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. J Pediatr. 4 0 obj 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 . 99411 is a number of codes. You may be required to fax or send the prescription if the breast pump will be shipped directly to your home. 4.2.2 One manual (E0602) or one standard electric (E0603) breast pump may be covered per birth event. The date the procedure is assigned to the Medicare outpatient group (MOG) payment group. 1 Pair Backflow Protectors. Providers must use procedure code E0602 or E0603 when billing for the purchase of a manual or non-hospital-grade electric breast pump. units, and the conversion factor.). Name - Physician: 9. E0602 Breast pump, manual, any type the Division will purchase; . remains hospitalized upon the mother's discharge. 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. x[o ~ NrZ~)&*K>"\"-c}{mv~=9~Y 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. . 2006. . 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. (E0602) or a standard, dual electric breast pump (E0603) is MEDICALLY APPROPRIATE for purchase for all women who choose to breast-feed. 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. u2qMm=X} Policy title change from Breastfeeding Reimbursement to Breast Pump Reimbursement. Medicare outpatient groups (MOG) payment group code. 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 <>>> The purchase of a breast pump is limited to one every three years. endobj Please click Continue to leave this website. 8. anesthesia procedure services that reflects all Standard electric breast pump (E0603): an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. BREAST PUMP CODE: E0602 Manual breast pump E0603 Personal use electric pump E0604 Hospital-grade electric pump rental and kit E0603 Breast pump, electric (AC and/or DC) any type Fgteev Lexi Height E0602 HCPCS code for Breast pump, manual, any type . The base unit represents the level of intensity for The physician orders or recommends the following breast pump for use by the member: Breast pump, manual, any type(E0602) - Purchase . The DME provider is responsible for repairs or replacement during the one-year warranty. XY$#+hi`A2~|>bM|^?TR" C8hyp>, 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. Subscribe to Codify by AAPC and get the code details in a flash. No other changes made. 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. 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. 30:4D-6o in accordance with, and subject to, the following policy. Indicator identifying whether a HCPCS code is subject Anderson JS, Johnstone Bm, Remley DT. To ensure timely access, a breast pump should be ordered . All other providers, including retail or online vendors, are considered out of network. Procedure Codes E0602 Accessories are considered eligible for benefits when the purchased breast pump is eligible for benefits. endobj 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). Code used to classify laboratory procedures according 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. 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. 2 0 obj E0602 and E0603 pumps are individual-use items to be kept by the member. Manual breast pumps of any type, including pedal powered, are covered under HCPCS procedure code E0602. The following breast pump replacement parts are limited to no more than two of each per year: A4281- Replacement breast pump tube . Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. All Rights Reserved". 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. endobj E0603 is a valid 2022 HCPCS code for Breast pump, electric (ac and/or dc), any type or just " Electric breast pump " for short, used in Other medical items or services . tables on the mainframe or CMS website to get the dollar amounts. This material is the confidential, proprietary and trade secret product of BlueCross BlueShield of South Carolina. Are you sure you want to leave this website? Breast-feeding of very low birth weight infants. This field is valid beginning with 2003 data. This item is available for rental only. Description of HCPCS Cross Reference Code #1, Description of HCPCS Cross Reference Code #2, Description of HCPCS Cross Reference Code #3, Description of HCPCS Cross Reference Code #4, Description of HCPCS Cross Reference Code #5. Interim review to update note regarding brands of pump available to include the Medela In-style pump beginning in February 2020. Information about E0602 HCPCS code exists in. Cochrane Database Syst Rev. 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 . Description of HCPCS MOG Payment Policy Indicator. Breast pumps* and replacement parts are covered for all KanCare female beneficiaries ages 12 through 55. meaningful groupings of procedures and services. The purchase of an electric breast pump is limited to one every three years. Breast Pumps E0602, E0603 Frequency: 1x/pregnancy Ages: All Breast Pump Supplies A4281, A4282, A4283, The Mya model will now be considered allowable for the no cost sharing breast pump purchases. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Only one (1) hospital grade pump is allowed per birth event. In: 2006 Red Book; Report of the Committee on Infectious Disease. "Current Procedural TerminologyAmerican Medical Association. 1993; 123(5): 773-778. Interim review to add the following verbiage: The Medela In-style pump will be discontinued in 2021 and replaced with the Medela Pump In Style Advanced model. Hospital grade heavy duty electric breast pump (E0604) is available only when provided as a rental and must have a prior authorization. . E0602/E0603 includes all necessary supplies and collection containers (kit). Any manual or electric pump billed within the same birth event as the original pump shall not be considered for reimbursement. A letter of medical necessity and/or the physician order may be requested on a post-service basis. Breast Pumps Breast Pumps HCPCS Code range E0602-E0604 The HCPCS codes range Breast Pumps E0602-E0604 is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims. (November 2021). Difference in morbidity between breast-fed adn formula-fed infants. Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with . HCPCS Code Description: Breast pump, electric (ac and/or dc), any type 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. What is the breast pump's HCPC code? E Codes E0603 HCPCS Code E0603 - Electric breast pump HCPCS Long Description: Contains all text of procedure or modifier long descriptions. E0602 Breast pump, manual Maximum . Request a Demo 14 Day Free . (See notes below; this benefit is specific to non . The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. 1999; 70(4): 525-535. beneficiaries and to individuals enrolled in private health % E0603 Breast pump, electric (AC and/or DC), any type: (A) The Division will purchase or rent on a monthly basis; (B) PA required; . (28 characters or less). 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. valid current code (or range of codes). 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. All rights reserved. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. As of 2013, this field contains the consumer friendly descriptions for the AMA CPT codes. The year the HCPCS code was added to the Healthcare common procedure coding system. collection of codes that represent procedures, supplies, 2017. In the case of a birth resulting in multiple infants, only one breast pump is covered. This includes but is not limited to prematurity, neonatal or maternal illness . Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. Interim review to update product list as Ameda has discontinued the Purely Yours pump and replaced it with the Finesse pump. 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. Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. A4282 - Adapter for breast pump, replacement . Breast pump, electric (AC andor DC), any type/ (E0603) - Purchase . 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 . 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. A prior authorization is required when utilized for more than 6 months. 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. Breast Pumps requested under codes E0602, E0603 are always approved automatically. Timer to track breast pumping sessions. A PA is required for billing either a manual breast pump (E0602) or an electric breast pump (E0603) in any of these situations: More than one breast pump is needed per lifetime. Berenson-Eggers Type Of Service Code Description. Web Get Your Pump in 3 . E0602 Breast pump, manual, any type. The carrier assigned CMS type of service which Copyright {{ ?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 However, rental of a hospital-grade, heavy-duty electrical breast pump requires prior authorization through the Medical Affairs Division. A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. E0604 Breast pump, heavy duty, hospital grade, piston operated, pulsatile vacuum suction/release cycles, vacuum regulator, supplied, transformer, electric (AC and/or DC) from payer . E0602. 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). (t_L7{{qSBk'MjgwSM E0603* Purchase of a personal-use, electric breast . This benefit is limited to one pump per birth. The Ameda Purely Yours pump was discontinued by the manufacturer in late. Interim review, adding the following verbiage to the policy: (See notes below, this benefit is specific to non-grandfathered plan members only). 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. Breast pump, manual, any type [rented reusable only] E0603 . In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding. Subscribe to Codify by AAPC and get the code details in a flash. For the initiation or continuation of breastfeeding, a manual or standard electric breast pump (E0602 or E0603) is considered medically necessary. E0603 - (breast pump, electric . NYS Medicaid covers three types of breast pumps. This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue CrossBlue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines. CPT is a registered trademark of the American Medical Association. A code denoting Medicare coverage status. .aH?HQ*Qe Ja\\%r0&RIZ! The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases. Number identifying the reference section of the coverage issues manual. E0602 - manual breast pump . Accessing Breast Pumps . A4281, A4282, A4283, A4284, A4285, A4286, E0602, E0603, E0604 . 2 storage bag adapters and 10 storage bags. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. Offering the wearable breast pumps The Willow & Elvie! Covers any manual pump including pedal powered. E0602 HCPCS Code E0602 Breast pump, manual, any type 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 . % Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that are not rentals appended with modifier -RR. <> This benefit is limited to one pump per birth. describes the particular kind(s) of service The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. 26th Ed/ Elk Grove Village, IL: AAP: 123-130. Horizon NJ Health will cover certain breastfeeding equipment and services consistent with the New Jersey Breastfeeding Support Law at N.J.S.A. If you are an established patient and need to reach labor and delivery, call 310-825-9111 for the BirthPlace Westwood or 424-259-9250 for the BirthPlace Santa Monica. Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. E0602 Breast pump, manual, any type HCPCS Procedure & Supply Codes E0602 - Breast pump, manual, any type The above description is abbreviated. Number identifying statute reference for coverage or noncoverage of procedure or service. HCPCS Code: E0603. to payment of an ASC facility fee, to a separate VKZ;X9T6;V_YQ6w%Ed Sg4!Au"suN~sq:19308uzTLnA3~R&|*sBi'rCd00\`hR])+)1Bsa)D!Q3`V.1S2\sylI3 Vh?i 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 . In addition, hormonal therapy, such as supplemental estrogen or progesterone, may be prescribed to mimic the effects of pregnancy. fee under another provision of Medicare, or to no All Rights Reserved. Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. 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. NOTE:Breast pumps must be obtained from contracted, network providers for in-network benefits to apply. pump (E0603) because of conditions of the mother or baby, which prevent normal suckling. procedure code based on generally agreed upon clinically x=k8?^DRb@w']d08m#LdVa6@DY/~C9~v?/?~r]z*yy|z, C~r%7+#("Ss,e08 |e|~z__P)"$cy|:c5_{`/ho3E;c!T(J9~^*!B} V%bF[ .Hr{Wx^%RMOhK%Y~@%|!_"L(7. Horizon NJ Health will not consider for reimbursement claims for more than one (1) manual breast pump (HCPCS code E0602) or one (1) electric breast pump (HCPCS code E0603) per birth event. Effective Date: January 1, 2021 Search: E0602 Breast Pump. In-person group lactation counseling classes will be considered for reimbursement by non-physician providers using HCPCS code S9446 (Patient education, not otherwise classified, non-physician provider, group, per session). products and services which may be provided to Medicare Kramer MS, Kakuma R. Optimal duration of exclusive breast-feeding. Breast pump, hospital grade, electric (AC and/or DC), any type (rented reusable only) NOTE: Electric Breast Pumps (E0603, E0604) will be purchase only with NU modifier effective October 1, 2013 . This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. Standard member benefits provide coverage for only one (1) manual (E0602) or electric (E0603) breast pump purchase per delivery. administration of fluids and/or blood incident to The monthly rental rate for hospital grade electric pumps has not changed. Lansinoh's Double Electric Breast Pump and the Evenflo Advanced Double Electric Breast Pump are two other well-reviewed pumps that are worth a look if you're in the market for a more affordable pump. Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. Breastfed infants have a lower risk of diarrhea and otitis media than bottle-fed infants during the first year of life. Horizon NJ Health will not consider for reimbursement lactation counseling and assistance (HCPCS codes S9443, S9446, 99441, 99442 and 99443) when billed by someone outside of the specialties of family practice, pediatrics or OB/GYN. %PDF-1.5 Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. Includes breast pump, comfortable silicone insert, nipple with collar, pump cap, bottle, bottle cap, bottle stand, bottle adaptor and . 2022 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. The 'YY' indicator represents that this procedure is approved to be
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