Horizon NJ Health will not consider for reimbursement breast pump supplies that exceed one (1) breast pump kit per birth event. Standard member benefits do not provide coverage for hospital-grade breast pumps (E0604). The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. The carrier assigned CMS type of service which Effective for claims 03/0/22, breast pump kit coverage has changed from two (2) kits to one (1) it. New Jersey Breastfeeding Support Law, N.J.S.A. Each part - up to 2 times within 12 months from the breast pump date of purchase. endobj Bier JB, Ferguson A, Anderson L, et al. Current recommendations from the American Academy of Pediatrics are to continue breastfeeding in infants through one year. 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. Limits. 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 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. 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). NOTE:Breast pumps must be obtained from contracted, network providers for in-network benefits to apply. These activities include 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 . The date that a record was last updated or changed. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. E0602 Breast pump, manual, any type the Division will purchase; . A4281 - replacement breast pump tube A4282 - adapter for breast pump, replacement . The base unit represents the level of intensity for The Berenson-Eggers Type of Service (BETOS) for the Last Updated on Fri, 24 Feb 2017 | Human Lactation. Verbiage added about billing a hands-free single-use pump. 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. The hospital grade electric breast pump is still being utilized by the mother. Description of HCPCS MOG Payment Policy Indicator. Breast pump rental may be medically appropriate for infants while they are detained in the hospital. Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that do not have a prior authorization. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. performed in an ambulatory surgical center. Annual review, no change to policy intent. Providers must use procedure code E0602 or E0603 when billing for the purchase of a manual or non-hospital-grade electric breast pump. 30:4D-6o. Once within 12 months from the date of birth. }`BZJ~?"pFrF}/>7R .|0smsY< HCiW,B\]_ZW+-U3_WI_j(2 Iwc.j'ts^XA The reimbursement rates for purchasing manual and electric (per sonal use) pumps have increased. 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. E0603 Breast pump, electric (AC and/ or DC), any type. VKZ;X9T6;V_YQ6w%Ed Sg4!Au"suN~sq:19308uzTLnA3~R&|*sBi'rCd00\`hR])+)1Bsa)D!Q3`V.1S2\sylI3 Vh?i E0602 - Breast pump, manual, any type E0603 - Breast pump, electric (AC and/or DC), any type . Public Statement. 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. Accessing Breast Pumps . The 'YY' indicator represents that this procedure is approved to be This benefit does not require prior authorization. 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. Number identifying the reference section of the coverage issues manual. All rights reserved. Offering the wearable breast pumps The Willow & Elvie! This means it must have an . 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. Only one (1) hospital grade pump is allowed per birth event. Breastfed infants have a lower risk of diarrhea and otitis media than bottle-fed infants during the first year of life. Find HCPCS E0602 code data using HIPAASpace API : The Healthcare Common Procedure Coding System (HCPCS) is a The purchase of a personal-use electric breast pump (HCPCS code E0603). The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. 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 provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. 4.2.2 One manual (E0602) or one standard electric (E0603) breast pump may be covered per birth event. fee at all. E0603. <>>> Interim review, adding the following verbiage to the policy: (See notes below, this benefit is specific to non-grandfathered plan members only). 30:4D-6o in accordance with, and subject to, the following policy. Information about E0602 HCPCS code exists in. For premature infants, breast milk may assist in preventing infections. Breast pump, hospital grade, electric (AC and/or DC), any type(E0604) - Rental only. A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. stream The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases. None of the services are associated with co-payments.xv 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. NOTE: The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. . NYS Medicaid covers three types of breast pumps. Prior authorization is required for circumstances beyond the standards of coverage and payment rules. 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. 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. Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. 2006. . . American Medical Association, Current Procedural Terminology (CPT) and associated publications and services. Pickering LK, Baker CJ, Long SS, McMillan JA, Eds. This benefit is limited to one pump per birth. Covers any manual pump including pedal powered. 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. Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. In the case of a birth resulting in multiple infants, only one breast pump is covered. administration of fluids and/or blood incident to 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. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. 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. may have one to four pricing codes. E0603 Breast pump, electric (AC and/or DC) any type. levels, or groups, as described Below: Short descriptive text of procedure or modifier code 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 . The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. 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. insurance programs. The DME provider is responsible for repairs or replacement during the one-year warranty. Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with modifier -SC. This field is valid beginning with 2003 data. Effective Jan. 1, 2023 A4283, A4284, A4285, A4286 and K1005 will be consideredMEDICALLY NECESSARY. Reference. 2 storage bag adapters and 10 storage bags. 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. 1993; 123(5): 773-778. 2002; (1): CD003517, milk versus maternal breast milk for feeding preterm or low birth weight infants. Billing for Breast Pumps Effective 10/01/2018, manual and automatic breast pumps (E0602 and E0603) are only available as a purchase under the mother's Medicaid Identification Number (MID). Anderson JS, Johnstone Bm, Remley DT. ), 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. 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 . Breast pump supply section verbiage amended. Any generally certified laboratory (e.g., 100) Adjustable speed and suction settings for maximum comfort and efficiency. (aWHd4'37S| co@O'q('opT# Bci aj"U(^n5x6. or a code that is not valid for Medicare to a The physician orders or recommends the following breast pump for use by the member: Breast pump, manual, any type(E0602) - Purchase . A4282 - Adapter for breast pump, replacement . 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. Number identifying statute reference for coverage or noncoverage of procedure or service. endobj As of 2013, this field contains the consumer friendly descriptions for the AMA CPT codes. could be priced under multiple methodologies. procedure code based on generally agreed upon clinically 4 0 obj HCPCS Code Description: Breast pump, electric (ac and/or dc), any type (t_L7{{qSBk'MjgwSM !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D (See notes below; this benefit is specific to nongrandfathered plan members only. 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) . This policy provides reimbursement guidelines for breast pumps, breast pump supplies and lactation counseling. valid current code (or range of codes). (November 2021). (November 2021). All parts must be submitted with modifier U8. Official Long Descriptor. All rights reserved. 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). Cochrane Database Syst Rev. Timer to track breast pumping sessions. Request a Demo 14 Day Free . Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. 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 year the HCPCS code was added to the Healthcare common procedure coding system. This includes but is not limited to prematurity, neonatal or maternal illness . (Note: the payment amount for anesthesia services A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. 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) or a standard, dual electric breast pump (E0603) is MEDICALLY APPROPRIATE for purchase for all women who choose to breast-feed. E0603 - (breast pump, electric . A4283 - Cap for breast pump bottle, replacement Last date for which a procedure or modifier code may be used by Medicare providers. Continued rental of a hospital-grade electric pump is considered. E0604. J Pediatr. A procedure NOTE:The Medela In-Style pump has been updated to Medela Pump in Style with Maxflow for 2022. A code denoting Medicare coverage status. This item is available for rental only. Breast pumps* and replacement parts are covered for all KanCare female beneficiaries ages 12 through 55. 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. collection of codes that represent procedures, supplies, 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. "Current Procedural TerminologyAmerican Medical Association. . QualChoice: Breast Pumps. 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. 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) . E0603* Purchase of a personal-use, electric breast . Members are entitled to one breast pump in a 12-month period. 26th Ed/ Elk Grove Village, IL: AAP: 123-130. In the case of a birth resulting in multiple . What is the breast pump's HCPC code? is based on a calculation using base unit, time Can be used for single or double pumping - Dual Accessory Kit Includes: 1 Pair Tubing. Continued rental of a hospital-grade electric pump is considered NOT MEDICALLY NECESSARY once the baby has been discharged. 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. The Ameda Purely Yours pump was discontinued by the manufacturer in late 2017. represented by the procedure code. <> Personal-use electric breast pump: The purchase of a personal-use electric breast pump (HCPCS code E0603). C~r%7+#("Ss,e08 |e|~z__P)"$cy|:c5_{`/ho3E;c!T(J9~^*!B} V%bF[ .Hr{Wx^%RMOhK%Y~@%|!_"L(7. % % You are leaving the Horizon NJ Health website. We verify your coverage and submit all required paperwork on your behalf. Interim review adding verbiage regarding the Ameda Mya Joy Plus pump. Code used to identify the appropriate methodology for E0603 Breast Pump, electric (AC and/or DC), any type The following code is covered: E0602 Breast Pump, manual any type RELATED POLICIES Preventive Services for Commercial Members Preauthorization via Web-Based Tool for Durable Medical Equipment (DME) PUBLISHED Provider Update Sept 2014 . The goal of the hospital grade pump is to . The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. [F=3f9C{rkHoe$@'2FZ)U=zmzmGTS?56A9m\4PKd-q'utD*1]o`:bJQwC6z )?t jONwE] HCPCS Code Description. J pediatr. _L5am#`0,5y4,.+O} @{)6L'TV8u]WR,HP"rQQZ`{%66U@0)XLEK~eU,UiqGWu y74szmMq t}Ix). once the baby has been discharged. (See notes below; this benefit is specific to nongrandfathered plan members only.). usual preoperative and post-operative visits, the Horizon NJ Health will cover certain breastfeeding equipment and services consistent with the New Jersey Breastfeeding Support Law at N.J.S.A. 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. 2007; (4): CD002971, Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. Please click Continue to leave this website. Manual breast pump (E0602):a non-electric pump that works by vacuum suction generated through biomechanical effort. <> A breast pump is a mechanical device used to extract milk from a lactating mother. Request a Demo 14 Day Free Trial Buy Now. beneficiaries and to individuals enrolled in private health new Date().getFullYear() }} BlueCross BlueShield of South Carolina. Type of Pump. 2017. Interim review to update product list as Ameda has discontinued the Purely Yours pump and replaced it with the Finesse pump. 3 0 obj Description: A breast pump is a mechanical device used to extract milk from a lactating mother. anesthesia procedure services that reflects all Manual breast pumps of any type, including pedal powered, are covered under HCPCS procedure code E0602. Code used to classify laboratory procedures according E Codes E0603 HCPCS Code E0603 - Electric breast pump HCPCS Long Description: Contains all text of procedure or modifier long descriptions. 2 0 obj E0602 Breast pump, manual, any type. 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. 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 . Copyright {{ hospital grade breast pump appropriate. Any unauthorized use, reproduction or transfer of these materials is strictly prohibited. The purchase of a breast pump is limited to one every three years. 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 . 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. What is a breast pump's CPT code? O09.33. Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). Breast pump rental may be medically appropriate for infants while they are detained in the hospital. Breast pump, manual, any type [rented reusable only] E0603 . 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. To ensure timely access, a breast pump should be ordered . No other changes made. units, and the conversion factor.). Web Manual Breast Pump purchase CPT Code E0602 Hospital Grade Electric Breast Pump rental CPT Code E0604 Individual Electric Breast Pump purchase CPT Code E0603. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. 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 . (terminated 12/31/2022). Note: Medical records must support the need for a hospital grade pump. Choose from the curated breast pumps, maternity compression and postpartum recovery items covered by . Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. <> Code used to identify instances where a procedure HCPCS Code E0602 - Manual breast pump. Breast Pump and Supplies Prescription Form Please complete this form and submit it with your initial claim online, by mail or fax. These are covered but no t more than one total per year . developing unique pricing amounts under part B. The date the procedure is assigned to the ASC payment group. pump (E0603) because of conditions of the mother or baby, which prevent normal suckling. E0603 Breast pump - electric any type. Kramer MS, Kakuma R. Optimal duration of exclusive breast-feeding. Rental of hospital grade breast pumps is limited to Durable Medical Equipment vendors. anesthesia care, and monitering procedures. A4281, A4282, A4283, A4284, A4285, A4286, E0602, E0603, E0604 . Rental of a Bill with modifier NU. Double Electric Breast Pump. E0602* Purchase of a personal-use, manual breast pump.
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