e0602 or e0603 breast pump

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 purchase of a personal-use electric breast pump (HCPCS code E0603). Please click Continue to leave this website. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. Subscribe to Codify by AAPC and get the code details in a flash. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. ARDO MEDICAL INC. HCPCS Code E0602 - Manual breast pump. A4282 - Adapter for breast pump, replacement . Offering the wearable breast pumps The Willow & Elvie! 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. fee at all. The Mya model will now be considered allowable for the no cost sharing breast pump purchases. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. 8TpVd2W){?~-n{cd4,*Ox E0602 Breast pump, manual, any type. Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. 4 0 obj anesthesia procedure services that reflects all HCPCS Code Description. No other changes made. to payment of an ASC facility fee, to a separate products and services which may be provided to Medicare 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) . 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 . represented by the procedure code. Last date for which a procedure or modifier code may be used by Medicare providers. The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. (terminated 12/31/2022). Interim review, adding the following verbiage to the policy: (See notes below, this benefit is specific to non-grandfathered plan members only). Interim review indicating that Ameda is phasing out the Finesse model and replacing it with the Mya model. A breast pump is a mechanical device used to extract milk from a lactating mother. 2 0 obj meaningful groupings of procedures and services. 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. 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 . E0602 Breast pump, manual, any type. The hospital grade electric breast pump is still being utilized by the mother. 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 . 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 . J Pediatr. Manual (E0602) Electric (E0603) Hospital Grade (E0604) Breast pump not prescribed (previously purchased by beneficiary) Difference in morbidity between breast-fed adn formula-fed infants. The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. Manual and electric breast pumps (E0602 and E0603) are available with a prescription to our members* through EmblemHealth participating durable medical equipment (DME) vendors. (See notes below; this benefit is specific to nongrandfathered plan members only. 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. . . 1995; 126(2): 191-197. The purchase of a breast pump is limited to one every three years. 1 0 obj Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. 1 Pair Backflow Protectors. "Current Procedural TerminologyAmerican Medical Association. Human milk. The Pump In Style Advanced model will now be considered for the no cost sharing breast pump purchases. E0602 Breast pump, manual, any type the Division will purchase; . J Pediatr. !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D Digital controls, LCD screen and nightlight. An explicit reference crosswalking a deleted code There are three basic types: Background: Breastfed infants have a lower risk of diarrhea and otitis media than bottle-fed infants during the first year of life. Effective January 1, 2016, Prevea360 Health Plan covers at 100% the purchase of one manual breast pump or one personal-use electric breast pump per birth. This benefit is limited to one pump per birth. In the case of a birth resulting in multiple infants, only one breast pump is covered. 7?4a2D`o$LO_N]g9$a`V,? 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. Request a Demo 14 Day Free Trial Buy Now (See notes below; this benefit is specific to nongrandfathered plan members only.). <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. Current recommendations from the American Academy of Pediatrics are to continue breastfeeding in infants through one year. 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. Indicator identifying whether a HCPCS code is subject Breast pumps* and replacement parts are covered for all KanCare female beneficiaries ages 12 through 55. fee under another provision of Medicare, or to no pump (E0603) because of conditions of the mother or baby, which prevent normal suckling. The purchase of an electric breast pump is limited to one every three years. <>>> is based on a calculation using base unit, time Copyright 2007-2022 HIPAASPACE. 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). Horizon NJ Health will cover certain breastfeeding equipment and services consistent with the New Jersey Breastfeeding Support Law at N.J.S.A. Breast pump, hospital grade, electric (AC and/or DC), any type(E0604) - Rental only. No prior approval needed. 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. An approval letter is sent via fax to the requestor (usually the ordering MD) as well as the vendor, Medical Group, and PCP (if different from the ordering MD). Code used to identify instances where a procedure or a code that is not valid for Medicare to a Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. E0602 - Breast Pump, Manual . Breast pump rental may be medically appropriate for infants while they are detained in the hospital. The Mya model will now be considered allowable for the no cost sharing breast pump purchases. Choose from the curated breast pumps, maternity compression and postpartum recovery items covered by . Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. 2006. . This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. E0602. To ensure timely access, a breast pump should be ordered . This policy provides reimbursement guidelines for breast pumps, breast pump supplies and lactation counseling. anesthesia care, and monitering procedures. E0603 Breast pump, electric (AC and/or DC) any type. endobj 1993; 123(5): 773-778. <>>> 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. administration of fluids and/or blood incident to Code used to identify the appropriate methodology for Any unauthorized use, reproduction or transfer of these materials is strictly prohibited. (Note: the payment amount for anesthesia services <> 2017. This means it must have an . Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. Members are entitled to one breast pump in a 12-month period. in 3 simple steps. E0604, heavy-duty hospital grade electric breast pumps are rental . 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. Access to this feature is available in the following products: Find-A-Code Essentials HCC Plus A4281 - replacement breast pump tube A4282 - adapter for breast pump, replacement . American Academy of Pediatrics (AAP). All other providers, including retail or online vendors, are considered out of network. 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 . Or, if you would like to remain in the current site, click Cancel. 1995; 126(5 Pt 1): 696-702. 1999; 70(4): 525-535. describes the particular kind(s) of service Breast pump parts for use with a pump that has been purchased. 3 0 obj This benefit does not require prior authorization. Any manual or electric pump billed within the same birth event as the original pump shall not be considered for reimbursement. Rental of a Code used to classify laboratory procedures according 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 date the procedure is assigned to the ASC payment group. speeding recovery from respiratory distress syndrome, increasing weight gain, protecting against retinopathy, and facilitating cognitive and visual development. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. The Ameda Purely Yours pump was discontinued by the manufacturer in late 2017. For the initiation or continuation of breastfeeding, a manual or standard electric breast pump (E0602 or E0603) is considered medically necessary. The purchase of a standard electric breast pump (E0603) will be covered. (November 2021). Supplies necessary for use of a breast pump, such as tubing (A4281) and adapter (A4282), are MEDICALLY APPROPRIATE and covered as necessary. Annual review, no change to policy intent, but, updating the model of the Medela pump available. x[o ~ NrZ~)&*K>"\"-c}{mv~=9~Y Standard electric breast pump (E0603): an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. BREAST PUMPS E0602/E0603 include all necessary supplies and collection containers (kit). Effective Date: January 1, 2021 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 2007; (4): CD002971, Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. The breast pump is provided in an off-campus outpatient hospital (place of service code 19), This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. Breast Pumps E0602, E0603 Frequency: 1x/pregnancy Ages: All Breast Pump Supplies A4281, A4282, A4283, 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. 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. 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 provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. Only one (1) hospital grade pump is allowed per birth event. Web Get Your Pump in 3 . NYS Medicaid covers three types of breast pumps. Access to this feature is available in the following products: This field is valid beginning with 2003 data. The Ameda Purely Yours pump was discontinued by the manufacturer in late. Last Updated on Fri, 24 Feb 2017 | Human Lactation. E0603 - (breast pump, electric . E0604. New Jersey Breastfeeding Support Law, N.J.S.A. [F=3f9C{rkHoe$@'2FZ)U=zmzmGTS?56A9m\4PKd-q'utD*1]o`:bJQwC6z )?t jONwE] Can be used for single or double pumping - Dual Accessory Kit Includes: 1 Pair Tubing. 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). This material is the confidential, proprietary and trade secret product of BlueCross BlueShield of South Carolina. 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 . 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. Annual review, no change to policy intent. E0602 Breast pump, manual Maximum . tables on the mainframe or CMS website to get the dollar amounts. E0602, manual breast pumps and E0603, personal electric breast pumps, are purchase only. 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. Copyright {{ Includes breast pump, comfortable silicone insert, nipple with collar, pump cap, bottle, bottle cap, bottle stand, bottle adaptor and . endobj Horizon NJ Health will not consider for reimbursement breast pump supplies that exceed one (1) breast pump kit per birth event. . In the case of a birth resulting in multiple . 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. E0602 Breast pump, manual, any type HCPCS Procedure & Supply Codes E0602 - Breast pump, manual, any type The above description is abbreviated. Prior authorization is required for circumstances beyond the standards of coverage and payment rules. Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. E0602 - Breast pump, manual, any type E0603 - Breast pump, electric (AC and/or DC), any type . Are you sure you want to leave this website? 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. developing unique pricing amounts under part B. Limits. Interim review adding verbiage regarding the Ameda Mya Joy Plus pump. .aH?HQ*Qe Ja\\%r0&RIZ! These are covered but no t more than one total per year . 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. 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. activities except time. E0602 Breast pump, manual, any type one E0603 #Breast pump, electric (AC and/or DC), any type one Kramer MS, Kakuma R. Optimal duration of exclusive breast-feeding. E0603 . 99411 is a number of codes. 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. 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% The following breast pump replacement parts are limited to no more than two of each per year: A4281- Replacement breast pump tube . 30:4D-6o in accordance with, and subject to, the following policy. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. 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. 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, The 'YY' indicator represents that this procedure is approved to be We verify your coverage and submit all required paperwork on your behalf. Breast-feeding and cognitive development; a meta-analysis. <> endobj Public Statement. QualChoice: Breast Pumps. However, rental of a hospital-grade, heavy-duty electrical breast pump requires prior authorization through the Medical Affairs Division. E Codes E0603 HCPCS Code E0603 - Electric breast pump HCPCS Long Description: Contains all text of procedure or modifier long descriptions.

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