1995; 126(5 Pt 1): 696-702. Breast pump, manual, any type [rented reusable only] E0603 . 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. In the case of a birth resulting in multiple infants, only one breast pump is covered. B{lth>azvz{jdm(KB\){MMi`onDDpK84u 2*DYFRJGJc&rX0$W=47Hpmfh1{0N W4eZ2}Y# b#vP"jQ1q^jR-tPMZMNPmicAb&$B;; +Jro nC2@8_b^xTa 30:4D-6o in accordance with, and subject to, the following policy. Subscribe to Codify by AAPC and get the code details in a flash. Description of HCPCS MOG Payment Policy Indicator. Copyright {{ Provide your insurance information. What is a breast pump's CPT code? levels, or groups, as described Below: Short descriptive text of procedure or modifier code Personal-use electric breast pump: The purchase of a personal-use electric breast pump (HCPCS code E0603). Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. 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). <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Includes breast pump, comfortable silicone insert, nipple with collar, pump cap, bottle, bottle cap, bottle stand, bottle adaptor and . speeding recovery from respiratory distress syndrome, increasing weight gain, protecting against retinopathy, and facilitating cognitive and visual development. Continued rental of a hospital-grade electric pump is considered. The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. It has been replaced by the Ameda Finesse pump, and this replacement model will be considered allowable for the no cost sharing breast pump purchases. All other providers, including retail or online vendors, are considered out of network. Online: www.tricare-west.com . All Rights Reserved". E0602 - Breast pump, manual, any type E0603 - Breast pump, electric (AC and/or DC), any type . 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 Dewey KG, Heninig MJ, Nommsen-Rivers LA. Offering the wearable breast pumps The Willow & Elvie! (terminated 12/31/2022). All parts must be submitted with modifier U8. 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 . % <> 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. The hospital grade electric breast pump is still being utilized by the mother. Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that do not have a prior authorization. E0603. stream 8TpVd2W){?~-n{cd4,*Ox 4 0 obj (See notes below; this benefit is specific to nongrandfathered plan members only. 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). Difference in morbidity between breast-fed adn formula-fed infants. New Jersey Breastfeeding Support Law, N.J.S.A. This includes but is not limited to prematurity, neonatal or maternal illness, neurological abnormalities, and anatomic abnormalities such as oro-facial or breast anomalies. Type of Pump. The Horizon name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. Manual and electric breast pumps (E0602 and E0603) are available with a prescription to our members* through EmblemHealth participating durable medical equipment (DME) vendors. Updating policy to include information regarding no cost share pumps allowed. This includes but is not limited to prematurity, neonatal or maternal illness . 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. Verbiage added about billing a hands-free single-use pump. Interim review adding verbiage regarding the Ameda Mya Joy Plus pump. HCPCS Code Description. 2 0 obj E0603 . endobj Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). 1993; 123(5): 773-778. once the baby has been discharged. pump (E0603) because of conditions of the mother or baby, which prevent normal suckling. The Mya model will now be considered allowable for the no cost sharing breast pump purchases. For premature infants, breast milk may assist in preventing infections. The carrier assigned CMS type of service which 2006. . 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. Additional Specs. 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. A code denoting the change made to a procedure or modifier code within the HCPCS system. Request a Demo 14 Day Free Trial Buy Now A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. 99411 is a number of codes. 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 The Ameda Purely Yours pump was discontinued by the manufacturer in late. Contains all text of procedure or modifier long descriptions. developing unique pricing amounts under part B. Request a Demo 14 Day Free . Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with modifier -SC. Indicator identifying whether a HCPCS code is subject HCPCS code range E0602-E0604 for breast pumps What is E0603, a HCPCS code? Double Electric Breast Pump. endobj The breast pump is provided in an off-campus outpatient hospital (place of service code 19), Standard member benefits provide coverage for only one (1) manual (E0602) or electric (E0603) breast pump purchase per delivery. 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. Hospital grade heavy duty electric breast pump (E0604) is available only when provided as a rental and must have a prior authorization. 1 0 obj Members are entitled to one breast pump in a 12-month period. In the case of a birth resulting in multiple . Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. to payment of an ASC facility fee, to a separate 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. A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. Code used to identify instances where a procedure The following breast pump replacement parts are limited to no more than two of each per year: A4281- Replacement breast pump tube . NOTE:Breast pumps must be obtained from contracted, network providers for in-network benefits to apply. Name - Physician: 9. 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. 30:4D-6o. new Date().getFullYear() }} BlueCross BlueShield of South Carolina. 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. A procedure NOTE: The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. _L5am#`0,5y4,.+O} @{)6L'TV8u]WR,HP"rQQZ`{%66U@0)XLEK~eU,UiqGWu y74szmMq t}Ix). tables on the mainframe or CMS website to get the dollar amounts. For the initiation or continuation of breastfeeding, a manual or standard electric breast pump (E0602 or E0603) is considered medically necessary. 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. Breast pump, electric (AC andor DC), any type/ (E0603) - Purchase . %PDF-1.5 fee under another provision of Medicare, or to no No other changes made. Harvard Breast pump supply section verbiage amended. Subscribe to Codify by AAPC and get the code details in a flash. A4281 - replacement breast pump tube A4282 - adapter for breast pump, replacement . 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. Subscribe to Codify by AAPC and get the code details in a flash. Standard member benefits do not provide coverage for hospital-grade breast pumps (E0604). 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. 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, (November 2021). No other changes made. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. Or, if you would like to remain in the current site, click Cancel. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. The monthly rental rate for hospital grade electric pumps has not changed. Are you sure you want to leave this website? In addition, hormonal therapy, such as supplemental estrogen or progesterone, may be prescribed to mimic the effects of pregnancy. The Mya model will now be considered allowable for the no cost sharing breast pump purchases. Rental of a describes the particular kind(s) of service Rental of the hospital-grade electric breast pump (E0604) will not be made if a personal use double electric breast pump (E0603) or a manual breast pump (E0602) has been purchased for the beneficiary. %PDF-1.5 Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. Reference. 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. Rental or purchase of hospital grade breast pumps is not covered. Horizon NJ Health will not consider for reimbursement lactation counseling or consultation (HCPCS codes S9443 and S9446) when billed by someone other than a nurse practitioner, physician assistant or nurse midwife. E0602 Breast pump, manual, any type. A4282 - Adapter for breast pump, replacement . Description: A breast pump is a mechanical device used to extract milk from a lactating mother. An explicit reference crosswalking a deleted code Breast pump, hospital grade, electric (AC and/or DC), any type(E0604) - Rental only. 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. Copyright 2007-2022 HIPAASPACE. 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 purchase of an electric breast pump is limited to one every three years. 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) . products and services which may be provided to Medicare Interim review to update product list as Ameda has discontinued the Purely Yours pump and replaced it with the Finesse pump. E0603 Breast pump - electric any type. xFtW0H(\_1B?2X<>&Ei/v7IMNbH|U!N0/AaZnZyEiTx5~M L$ijE@Z+ZjQ[1^%B/]%JeqI3W?a%deU_'TfKlc2J+*# 14+74wC638I(7w?z@cG/=dz 2007; (4): CD002971, Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. 3 0 obj NOTE: The Medela In-style pump will be discontinued in 2021 and replaced with the Medela Pump In Style Advanced model. x[o ~ NrZ~)&*K>"\"-c}{mv~=9~Y Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross Blue Shield Association. For premature infants, breast milk may assist in preventing infections, speeding recovery from respiratory distress syndrome, increasing weight gain, protecting against retinopathy, and facilitating cognitive and visual development. A letter of medical necessity and/or the physician order may be requested on a post-service basis. E0602. It has been replaced by the Ameda Finesse pump, and this replacement model will be considered allowable for the no cost sharing breast pump purchases. 8. may have one to four pricing codes. You are leaving the Horizon NJ Health website. Human milk. Accessing Breast Pumps . Supplies necessary for use of a breast pump, such as tubing (A4281) and adapter (A4282), are MEDICALLY APPROPRIATE and covered as necessary. Only one (1) hospital grade pump is allowed per birth event. in 3 simple steps. 7?4a2D`o$LO_N]g9$a`V,? Continued rental of a hospital-grade electric pump is considered NOT MEDICALLY NECESSARY once the baby has been discharged. <>>> Web Get Your Pump in 3 . CPT Code(s): A4281-A4286, E0602-E0604. 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. Number identifying statute reference for coverage or noncoverage of procedure or service. The reimbursement rates for purchasing manual and electric (per sonal use) pumps have increased. Procedure Codes A4281 A4282 A4283 A4284 A4285 A4286 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. J Pediatr. Pickering LK, Baker CJ, Long SS, McMillan JA, Eds. What is the breast pump's HCPC code? (Note: the payment amount for anesthesia services <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. 1 0 obj A prior authorization is required when utilized for more than 6 months. 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. The year the HCPCS code was added to the Healthcare common procedure coding system. Manual breast pump (E0602):a non-electric pump that works by vacuum suction generated through biomechanical effort. hospital grade breast pump appropriate. The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases. This field is valid beginning with 2003 data. Effective for claims 03/0/22, breast pump kit coverage has changed from two (2) kits to one (1) it. You may be required to fax or send the prescription if the breast pump will be shipped directly to your home. This means it must have an . The date the procedure is assigned to the Medicare outpatient group (MOG) payment group. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. endobj This benefit is limited to one pump per birth. activities except time. Any manual or electric pump billed within the same birth event as the original pump shall not be considered for reimbursement. O09.33. Last Updated on Fri, 24 Feb 2017 | Human Lactation. Number identifying the reference section of the coverage issues manual. Breast pump rental may be medically appropriate for infants while they are detained in the hospital. An electric breast pump may only be purchased when cost effective for one of the following conditions: (i) . E0602 Breast pump, manual, any type. 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. Any generally certified laboratory (e.g., 100) endobj Berenson-Eggers Type Of Service Code Description. The 'YY' indicator represents that this procedure is approved to be !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D E Codes E0603 HCPCS Code E0603 - Electric breast pump HCPCS Long Description: Contains all text of procedure or modifier long descriptions. The codes are divided into two This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. E0602 - Breast Pump, Manual . 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. Bill with modifier NU. 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 . Public Statement. All claims for breast pumps (E0602, E0603 and E0604), breast pump supplies (A4281, A4282, A4283, A4284, A4285, A4286 and K1005) and lactation counseling (S9443, S9446, 99441, 99442 and 99443) must have one of the following diagnosis codes: O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.211, O09.212, O09.213, O09.219, O09.291, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32. Current recommendations from the American Academy of Pediatrics are to continue breastfeeding in infants through one year. 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 . HCPCS Code E0602 - Manual breast pump. <>>> Includes. E0604, heavy-duty hospital grade electric breast pumps are rental . This policy provides reimbursement guidelines for breast pumps, breast pump supplies and lactation counseling. 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 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. 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. anesthesia care, and monitering procedures. Policy Statement: A dual manual (E0602) or a standard, dual electric breast pump (E0603) is MEDICALLY APPROPRIATE for purchase for all women who choose to breastfeed. (c) Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with . All Rights Reserved. 1999; 70(4): 525-535. [F=3f9C{rkHoe$@'2FZ)U=zmzmGTS?56A9m\4PKd-q'utD*1]o`:bJQwC6z )?t jONwE] Number identifying the processing note contained in Appendix A of the HCPCS manual. (aWHd4'37S| co@O'q('opT# Bci aj"U(^n5x6. Notwithstanding the foregoing, all payment determinations are subject to all other, applicable limitations, including but not limited to, the following: CPT Copyright 2017 American Medical Association. Access to this feature is available in the following products: No prior approval needed. (E0602) or a standard, dual electric breast pump (E0603) is MEDICALLY APPROPRIATE for purchase for all women who choose to breast-feed. % A breast pump is a mechanical device used to extract milk from a lactating mother. Interim review to add the following verbiage: The Medela In-style pump will be discontinued in 2021 and replaced with the Medela Pump In Style Advanced model. American Medical Association, Current Procedural Terminology (CPT) and associated publications and services. Rental of hospital grade breast pumps is limited to Durable Medical Equipment vendors. Standard electric breast pump (E0603):an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. lnq.'$scXkUY?(%[*n_\ a[Zd]^L 0Z]8S.BHdbmC~mUM 96piVS.KZaKP pw*5hZnbo:l{(, Search Results. The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases.. Annual review, no change to policy intent. Cochrane Database Syst Rev. . Last Updated: March 27, 2022. A4281, A4282, A4283, A4284, A4285, A4286, E0602, E0603, E0604 . To ensure timely access, a breast pump should be ordered . Medicare outpatient groups (MOG) payment group code. may perform any of the tests in its subgroups (e.g., 110, 120, etc.). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Lactation cannot be initiated in the normal fashion or with a standard electric pump (E0603) because of conditions of the mother or baby, which prevent normal suckling. 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 . Search: E0602 Breast Pump. units, and the conversion factor.). beneficiaries and to individuals enrolled in private health (November 2021). Request a Demo 14 Day Free Trial Buy Now Official Long Descriptor Breast pump, manual, any type Crosswalks HCPCS MODIFIERS could be priced under multiple methodologies. E0602* Purchase of a personal-use, manual breast pump. 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 .
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