Breast Pumps and Lactation Services - HealthyCT

Breast Pumps and Lactation Services - HealthyCT

Benefit Payment Guideline Breast Pumps and Lactation Services Benefit Policy Statement: HealthyCT (HCT) provides coverage for breast pumps and breast...

212KB Sizes 0 Downloads 1 Views

Recommend Documents

Breast Pumps And Lactation Consultation Services - DMAS
Jan 1, 2016 - reimburse for lactation consultation services and breast pumps for pregnant and postpartum women in the fe

CoreSource Health Claim Form for Lactation Services and Breast Pumps
Claim Form Completion Instructions for Lactation Services and Hospital Grade Breast Pumps. These instructions outline in

Breast Pumps and Supplies - Tricare
Jul 24, 2015 - Storage bags. • Up to 2 breast pump kits per birth event. TRICARE doesn't cover (unless part of a breas

Breast Pumps - Univera Healthcare
A new set of breast pump supplies are eligible for coverage with each subsequent pregnancy. V. For grandfathered groups:

Breast Pumps And Accessories - Northwood Inc.
Breast Pumps and Accessories. Medical Policy. Breast Pumps and Accessories. Description. A breast pump is a suction devi

PI-122 Resources for Breast Pumps and Breast - University Hospitals
Selecting a breast pump: • Efficiency: A pump with a quick suck/ release cycle will elicit a better “letdown” and

Breast pumps and pump accessories - OHSU
(1) Tote bag with integrated motor unit; (1) AC. Adaptor ... included); (1) insulated cooler bag and ice pack includes:

Breast Pumps and Insurance Coverage - URMC
The Affordable Care Act (ACA) is a new law which requires private health ... Most Medicaid plans (including Medicaid, Fi

Breast Pumps and Insurance Coverage - URMC
Breast Pumps and Insurance Coverage –. The Affordable Care Act (ACA) is a new law which requires health insurance plan

Breast pumps - AmeriHealth Caritas Louisiana
Mar 1, 2014 - AmeriHealth Caritas Louisiana considers the use of breast pumps to be ... A new set of breast pump supplie

Benefit Payment Guideline

Breast Pumps and Lactation Services Benefit Policy Statement: HealthyCT (HCT) provides coverage for breast pumps and breastfeeding support, counseling, and equipment for the duration of breastfeeding with no member cost share per the ACA.

_______________________________________________________________________________________________________________________

Benefit Policy Guidelines: Breast Pumps: •

• • • •

Standard manual or standard electric breast pump models are covered for purchase up to the amount of the contracted allowable rate with no member cost share through a participating provider. Hospital grade breast pumps are not covered. Must be obtained through a HCT participating DME provider with a practitioner’s prescription. Breast pumps purchased form retail stores such as Target or Wal-Mart are not DME companies and therefore will not be covered. A replacement manual breast pump is considered medically necessary for each subsequent pregnancy A replacement standard electrical breast pump is considered medically necessary for subsequent pregnancies, if the initial electric breast pump is broken and out of warranty.

Breast Pump Supplies

HCT covers the following breast pump-related items: • Tubing for breast pump • Adapter for breast pump, replacement • Cap for breast pump, replacement • Breast shield and splash protector for use with breast pump, replacement • Polycarbonate bottle for use with breast pump, replacement • Locking ring for breast pump, replacement

HCT does not cover the following breast pump-related items: • Baby weight scales • Batteries, battery-powered adaptors, and battery packs • Bottles which are not specific to breast pump operation including the associated bottle nipples, caps and lids • Breast milk storage bags, ice-packs, labels, labeling lids, and other similar products

Proprietary and Confidential Benefit Payment Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and therefore is subject to change. >>Breast Pumps and Lactation Services: Approved at 8/10/2015 PIC meeting

• • • • • •

Breast pump cleaning supplies including soap, sprays, wipes, steam cleaning bags and other similar products Creams, ointments, and other products that relieve breasts or nipples Electrical power adapters for travel Garments or other products that allow hands-free pump operation Nursing bras, bra pads, breast shells, nipple shields, and other similar products Travel bags, and other similar travel or carrying accessories

Lactation Support

Comprehensive lactation support and counseling, by a trained, participating provider during pregnancy and/or in the postpartum period is covered by HCT at no member cost share when provided by a participating OB/GYN or Pediatrician through his or her office or by a participating hospital.

The following hospitals have been designated Baby Friendly Hospital Initiative designation (established by the World Health Organization [WHO]/UNICEF): https://www.babyfriendlyusa.org/find-facilities/designatedfacilities--by-state • Griffin Hospital, Derby • Harford Hospital, Hartford • Lawrence and Memorial Hospital, New London • Middlesex Hospital, Middletown • MidState Medical Center, Meriden • St. Vincent’s Medical Center, Bridgeport • The Hospital of Central Connecticut, New Britain • The Hospital of Saint Raphael, New Haven

LOB:

Commercial – On exchange and off exchange ☒Large group ☒Small group ☒Individual

Examples of Claim Adjudication Scenarios: 1. Member purchases a breast pump at a retail store and submits a claims to HCT. The claim will be denied. Breast pumps must be purchased at a HCT participating DME provider with a prescription to be covered with no member cost share. 2. Member wants coverage for creams, ointments, and other products that relieve breasts or nipples. These products will be denied as not a covered benefit. Proprietary and Confidential Benefit Payment Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and therefore is subject to change. >>Breast Pumps and Lactation Services: Approved at 8/10/2015 PIC meeting

3. Member has a referral for lactation counseling, receives services, HCT will cover with no member cost share.

Member Cost-Sharing: Copay/Deductible according to benefit summary

One breast pump will be covered at no cost sharing for female members any time during their pregnancy or following delivery when purchased from and in-network DME provider.

Breastfeeding support, counseling, and equipment are covered without member cost share when provided by an in-network OB/GYN or Pediatrician through his or her office or by a participating hospital.

Provider Guidelines:

Prior authorization is not required. Provider must write a prescription for the member to obtain a breast pump and supplies from a participating DME vendor.

Coding

Breast Pumps - Covered E0602 E0603

Breast Pumps – Not Covered E0604

Breast pump, manual, any type Breast pump, electric (AC and/or DC), any type

Breast pump, hospital grade, electric (AC and/or DC), any type

Breast Pump Accessories - Covered A4281 A4282 A4283 A4284 A4285 A4286

Tubing for breast pump Adapter for breast pump, replacement Cap for breast pump, replacement Breast shield and splash protector for use with breast pump, replacement Polycarbonate bottle for use with breast pump, replacement Locking ring for breast pump, replacement

Lactation Support and Counseling; Must be submitted with Diagnosis Codes: V24.1-Postpartum care and examination; Lactating mother or 779.31-Feeding problems in newborn. S9443 99201-99203 99211-99214 99241-99245 99341-99345 99347-99350 99401 99402 99403 99404

Lactation classes, non-physician provider, per session New patient E&M codes E&M codes Office consultation E&M codes New patient home visit Established patient home visit Preventive medicine counseling/risk factor reduction, 15 minutes Preventive medicine counseling/risk factor reduction, 30 minutes Preventive medicine counseling/risk factor reduction, 45 minutes Preventive medicine counseling/risk factor reduction, 60 minutes

Proprietary and Confidential Benefit Payment Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and therefore is subject to change. >>Breast Pumps and Lactation Services: Approved at 8/10/2015 PIC meeting

Exclusions/Limitations: 1. Services provided by non-participating vendors/providers 2. Breast pump, hospital grade, electric (AC and/or DC), any type (The law does not require coverage of all types of pumps) 3. Services provided by La Leche League 4. The following supplies are not covered: • Baby weight scales • Batteries, battery-powered adaptors, and battery packs • Bottles which are not specific to breast pump operation including the associated bottle nipples, caps and lids • Breast milk storage bags, ice-packs, labels, labeling lids, and other similar products • Breast pump cleaning supplies including soap, sprays, wipes, steam cleaning bags and other similar products • Creams, ointments, and other products that relieve breasts or nipples • Electrical power adapters for travel • Garments or other products that allow hands-free pump operation • Nursing bras, bra pads, breast shells, nipple shields, and other similar products • Travel bags, and other similar travel or carrying accessories

References: ACA

Document History 8/10/2015

Initial Version

Proprietary and Confidential Benefit Payment Guidelines are developed by HealthyCT to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Guideline may contain only a partial, general description of plan or program benefits and does not constitute a contract. This Guideline may be updated and therefore is subject to change. >>Breast Pumps and Lactation Services: Approved at 8/10/2015 PIC meeting