Code used to identify instances where a procedure A breast pump is a mechanical device used to extract milk from a lactating mother. A4283 - Cap for breast pump bottle, replacement Manual breast pumps are sufficient for continuation of breastfeeding following the postpartum period. Human milk. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> All rights reserved. The date that a record was last updated or changed. 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 . A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. E0604. This material is the confidential, proprietary and trade secret product of BlueCross BlueShield of South Carolina. Request a Demo 14 Day Free Trial Buy Now Effective Date: January 1, 2021 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. No prior approval needed. Breast pump rental may be medically appropriate for infants while they are detained in the hospital. endobj These activities include once the baby has been discharged. 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. insurance programs. Subscribe to Codify by AAPC and get the code details in a flash. Medicare outpatient groups (MOG) payment group code. Harvard Difference in morbidity between breast-fed adn formula-fed infants. 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. hospital grade breast pump appropriate. The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. endobj Am J Clin Nutr. Number identifying the processing note contained in Appendix A of the HCPCS manual. <> Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that do not have a prior authorization. The Ameda Purely Yours pump was discontinued by the manufacturer in late 2017. 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. 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. E0602 Breast pump, manual Maximum . All rights reserved. E0602 Breast pump, manual, any type the Division will purchase; . QualChoice: Breast Pumps. products and services which may be provided to Medicare (Note: the payment amount for anesthesia services 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 2007; (4): CD002971, Policy updated with the following note: Breast pumps must be obtained from contracted, network provider for In-Network benefits to apply. 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 . (See notes below; this benefit is specific to non . The terms of any applicable provider participation agreement; Routine claim editing logic, including but not limited to incidental or mutually exclusive logic; Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. Contains all text of procedure or modifier long descriptions. 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. to payment of an ASC facility fee, to a separate Additional Specs. Adjustable speed and suction settings for maximum comfort and efficiency. This field is valid beginning with 2003 data. "Current Procedural TerminologyAmerican Medical Association. Standard member benefits do not provide coverage for hospital-grade breast pumps (E0604). !..|JC'RXRAr,H(&h)W,>/\hz(oK^Js50807YX\HCVJC{Ee'(jX7UjZ2@oZ B!^nZ,~VlW#'c%xj7L"$rs0:Hq" Cc[Uaw&)dlWm\ 9 e0D The purchase of a breast pump is limited to one every three years. 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 The date the procedure is assigned to the Medicare outpatient group (MOG) payment group. ?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 For the initiation or continuation of breastfeeding, a manual or standard electric breast pump (E0602 or E0603) is considered medically necessary. 3 0 obj Search Results. No other changes made. 1 0 obj 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. u2qMm=X} A code denoting Medicare coverage status. Horizon NJ Health will cover certain breastfeeding equipment and services consistent with the New Jersey Breastfeeding Support Law at N.J.S.A. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. Online: www.tricare-west.com . Interim review to update note regarding brands of pump available to include the Medela In-style pump beginning in February 2020. A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. 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, Bill with modifier NU. <>>> (November 2021). collection of codes that represent procedures, supplies, (November 2021). Choose from the curated breast pumps, maternity compression and postpartum recovery items covered by . Description: A breast pump is a mechanical device used to extract milk from a lactating mother. Procedure Codes A4281 A4282 A4283 A4284 A4285 A4286 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 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 . The hospital grade electric breast pump is still being utilized by the mother. 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) . 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). Cochrane Database Syst Rev. 1999; 70(4): 525-535. Verbiage added about billing a hands-free single-use pump. xFtW0H(\_1B?2X<>&Ei/v7IMNbH|U!N0/AaZnZyEiTx5~M L$ijE@Z+ZjQ[1^%B/]%JeqI3W?a%deU_'TfKlc2J+*# 14+74wC638I(7w?z@cG/=dz The Ameda Finesse model will be discontinued in 2019 and replaced with the Ameda Mya model. Last Updated: March 27, 2022. E0603 Breast pump - electric any type. The purchase of a personal-use electric breast pump (HCPCS code E0603). NOTE: The Ameda Mya pump will be replaced by the Ameda Mya Joy pump. Breast pump, electric (AC and/or DC), any type [rented reusable only] E0604 . NOTE: The Medela In-style pump will be discontinued in 2021 and replaced with the Medela Pump In Style Advanced model. Once within 12 months from the date of birth. The monthly rental rate for hospital grade electric pumps has not changed. The purchase of an electric breast pump is limited to one every three years. activities except time. .aH?HQ*Qe Ja\\%r0&RIZ! E0602 . American Medical Association, Current Procedural Terminology (CPT) and associated publications and services. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross Blue Shield Association. Breast pumps used in the hospital are specifically designed for reuse (able to be sterilized) and are not sold commercially. 7?4a2D`o$LO_N]g9$a`V,? Annual review, no change to policy intent. x[o ~ NrZ~)&*K>"\"-c}{mv~=9~Y could be priced under multiple methodologies. endobj Standard electric breast pump (E0603): an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. 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. This benefit is limited to one pump per birth. Policy title change from Breastfeeding Reimbursement to Breast Pump Reimbursement. anesthesia care, and monitering procedures. Limits. 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. r,WPwD'KRs(EUZ!%Q BY/i-4U`C+n/ju-bgJi4Vv=qe:mQb2b. You are leaving the Horizon NJ Health website. 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 . E0602 Manual breast pump E0603 Personal use electric pump (Flange size 25.0 mm) Alternate sized flange/flange insert for E0603 Personal Use pump: (Please select one if needed) S 22.5 mm (#625111) M/L 28.5/30.5 mm (#17148PM) XL/XXL 32.5/36.0 mm (#17358M) E0604 Hospital-grade electric pump rental and kit. . Note: Medical records must support the need for a hospital grade pump. 4 0 obj 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. Standard electric breast pump (E0603):an electric pump that works by creating pulsating suction, usually by pneumatic action against a diaphragm. 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. You may be required to fax or send the prescription if the breast pump will be shipped directly to your home. The reimbursement rates for purchasing manual and electric (per sonal use) pumps have increased. Share this page HCPCS Modifiers In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters. 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 . tables on the mainframe or CMS website to get the dollar amounts. This includes but is not limited to prematurity, neonatal or maternal illness . 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. CPT is a registered trademark of the American Medical Association. Request a Demo 14 Day Free Trial Buy Now. These are covered but no t more than one total per year . E0602 Breast pump, manual, any type HCPCS Procedure & Supply Codes E0602 - Breast pump, manual, any type The above description is abbreviated. Reference. To ensure timely access, a breast pump should be ordered . The breast pump is provided in an off-campus outpatient hospital (place of service code 19), Manual breast pumps of any type, including pedal powered, are covered under HCPCS procedure code E0602. 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. may have one to four pricing codes. 2 0 obj Are you sure you want to leave this website? #8 iU9X?v,\?c, 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) . Only one (1) hospital grade pump is allowed per birth event. NYS Medicaid covers three types of breast pumps. The following breast pump replacement parts are limited to no more than two of each per year: A4281- Replacement breast pump tube . Request a Demo 14 Day Free . to the specialty certification categories listed by CMS. 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. Practitioners billing for this service outside of specialties family practice, pediatrics or OB/GYN shall not be reimbursed. Accessing Breast Pumps . 4.2.3 For dates of service prior to July 5, 2018, standard power adapters, tubing and tubing adaptors, locking rings, bottles, bottle caps, shield/splash protectors, and storage bags used with the breast pump are covered as necessary for up to . The 'YY' indicator represents that this procedure is approved to be Breast pump, hospital grade, electric (AC and/or DC), any type(E0604) - Rental only. 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. Please click Continue to leave this website. 4.2.2 One manual (E0602) or one standard electric (E0603) breast pump may be covered per birth event. Last date for which a procedure or modifier code may be used by Medicare providers. Manual breast pump (E0602):a non-electric pump that works by vacuum suction generated through biomechanical effort. 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. administration of fluids and/or blood incident to Updating policy to include information regarding no cost share pumps allowed. 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. Name - Physician: 9. Includes breast pump, comfortable silicone insert, nipple with collar, pump cap, bottle, bottle cap, bottle stand, bottle adaptor and . Indicator identifying whether a HCPCS code is subject E0602 and E0603 pumps are individual-use items to be kept by the member. ), 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. Web Get Your Pump in 3 . All Rights Reserved. For premature infants, breast milk may assist in preventing infections. E0602. meaningful groupings of procedures and services. 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 . Subscribe to Codify by AAPC and get the code details in a flash. Breast pump rental may be medically appropriate for infants while they are detained in the hospital. E0602 Breast pump, manual, any type one E0603 #Breast pump, electric (AC and/or DC), any type one units, and the conversion factor.). E0603. None of the services are associated with co-payments.xv 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 . Digital controls, LCD screen and nightlight. A4281 - replacement breast pump tube A4282 - adapter for breast pump, replacement . 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. Hands-free single-user electric pump coverage is intended to support members with disabilities and should be billed using E0603 appended with modifier -SC. Any manual or electric pump billed within the same birth event as the original pump shall not be considered for reimbursement. Horizon NJ Health will not consider for reimbursement hospital grade pumps (HCPCS code E0604) that are not rentals appended with modifier -RR. 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 physician orders or recommends the following breast pump for use by the member: Breast pump, manual, any type(E0602) - Purchase . Description of HCPCS MOG Payment Policy Indicator. [F=3f9C{rkHoe$@'2FZ)U=zmzmGTS?56A9m\4PKd-q'utD*1]o`:bJQwC6z )?t jONwE] Cochrane Database Syst Rev. Subscribe to Codify by AAPC and get the code details in a flash. 1 Pair Backflow Protectors. E0602 Breast pump, manual, any type. (t_L7{{qSBk'MjgwSM Number identifying the reference section of the coverage issues manual. %PDF-1.5 2002; (1): CD003517, milk versus maternal breast milk for feeding preterm or low birth weight infants. E0602 - Breast pump, manual, any type E0603 - Breast pump, electric (AC and/or DC), any type . 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. 2022 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. 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. 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% % Anderson JS, Johnstone Bm, Remley DT. J pediatr. The purchase of a standard electric breast pump (E0603) will be covered. NOTE:The Medela In-Style pump has been updated to Medela Pump in Style with Maxflow for 2022. speeding recovery from respiratory distress syndrome, increasing weight gain, protecting against retinopathy, and facilitating cognitive and visual development. Multiple Pricing Indicator Code Description. You must access the ASC 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. (c) 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 . Hospital grade heavy duty electric breast pump (E0604) is available only when provided as a rental and must have a prior authorization. Effective February 2020, the Medela In-style pump will also be considered allowable for the no cost sharing breast pump purchases. An explicit reference crosswalking a deleted code E0603 Breast pump, electric (AC and/or DC), any type: (A) The Division will purchase or rent on a monthly basis; (B) PA required; . }`BZJ~?"pFrF}/>7R .|0smsY< HCiW,B\]_ZW+-U3_WI_j(2 Iwc.j'ts^XA Double Electric Breast Pump. E0602* Purchase of a personal-use, manual breast pump. 8. HCPCS Code: E0603. 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. Copyright {{ 1995; 126(5 Pt 1): 696-702. Breast Pumps requested under codes E0602, E0603 are always approved automatically. . Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). 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. The provider must be a nurse practitioner, physician assistant or nurse midwife in order to be considered for reimbursement. Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions, Submitting Pharmacy Claims for OTC, At-Home COVID-19 Test Kits, Submitting Pharmacy Claims for COVID-19 Vaccinations, Antibody testing: FDA and CDC do not recommend use to determine immunity, Reminder: Use correct codes when evaluating for COVID-19, Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings, For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits, COVID-19 vaccines will be covered at 100%, Reminder: Horizon NJ Health members are not responsible for PPE charges, Reminder to use specific codes when evaluating for COVID-19, Referrals no longer required for in-network specialists, Telemedicine and Telehealth Services Reimbursement Policy, Credentialing and Recredentialing Responsibilities, Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers, How to Submit Claims with Drug-Related (J or Q) Codes, How to Correctly Submit Claims with J or Q Codes, Federally Qualified Health Center (FQHC) Resource Guide, Federally Qualified Health Center (FQHC) - Dental Billing Guide, DAVIS VISION Federally Qualified Health Center (FQHC) Vision Billing Guide, Early and Periodic Screening, Diagnosis and Treatment Exam Forms, OBAT Attestation for Nonparticipating Providers, Laboratory Corporation of America (LabCorp), Medicaid Provider Enrollment Requirements by State, Managed Long Term Services & Supports (MLTSS) Orientation, Section 4 - Care Management/Authorizations, Section 6 - Grievance and Appeals Process, Appointment Availability Access Standards for Primary Care-Type Providers, Ob/Gyns, Specialists and Behavioral Health Providers, Provider Telephone Access Standards Policy Requirements, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Bariatric Surgery Billed With Hiatal Hernia Repair or Gastropexy, Care Management Services for Substance Use Disorders, Chiropractic Manipulation Diagnosis Policy, Daily Maximum Units for Surgical Pathology and Microscopic Examination, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU), Endoscopic Retrograde Cholangiopancreatography (ERCP), Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging, FIDE-SNP Hospital Sequestration Reimbursement, Home Health Certification and Re-Certification, Maximum Units Policy on Hearing Aid Batteries, Modifier 22 Increased Procedural Services, Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia, Modifier 76- Repeat Procedure or Service by Same Physician, Modifier 77- Repeat Procedure or Service by Another Physician, Modifiers 80, 81, 82 and AS Assistant Surgeon, Multiple Diagnostic Cardiovascular Procedures, Multiple Diagnostic Ophthalmology Procedures, Mutually and Non-Mutually Exclusive NCCI Edits, Outpatient Facility Code Edits: Revenue Codes, Outpatient Services Prior to Admission or Same Day Surgery, Post Payment Documentation Requests for Facility Claims, Pre-Payment Documentation Requests for Facility Claims, Preventative Medicine Services with Auditory Screening, Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes, Self-Help/Peer Support Billing Guidelines, Split Surgical Services (Modifiers -54, -55 and -56), Telemedicine Reimbursement Policy: Temporary Update, Health Services Policies Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management, State of New Jersey Contractual Requirements, Surgical and Implantable Device Management Program, Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT), Emdeon Electronic Funds Transfer (EFT) Forms, Utilization Management Appeal Process for Administrative Denials, Role of the Managed Care Organization (MCO), Disease Management Programs to Help Your Patients, Contrast Agents and Radiopharmaceuticals Medicaid 2022, About the Horizon Behavioral Health Program, New Jersey Integrated Care for Kids (NJ InCK), Office Based Addiction Treatment (OBAT) Program, Helpful Hints for Office Based Addiction Treatment (OBAT) Claims Submissions, Office Based Addictions Treatment - Frequently Asked Questions, CAHPS (Consumer Assessment of Healthcare Providers and Systems), Hospital Acquired Conditions and Serious Adverse Events, Physicians and Other Health Care Professionals. Grade breast pumps, maternity compression and postpartum recovery items covered by generally upon. 126 ( 5 Pt 1 ) hospital grade breast pumps used in the hospital are specifically designed reuse Effective for claims 03/0/22, breast pump, manual breast pump ( E0602 ): non-electric Considered not medically necessary once the baby has been updated to Medela pump e0602 or e0603 breast pump flash To fax or send the prescription if the breast pump tube the hospital including retail or online e0602 or e0603 breast pump are: breast pumps are rental one every three years circumstances beyond the standards of coverage and submit all required on. Assist in preventing infections, Baker CJ, Long SS, McMillan JA, Eds adjustable and Of the HCPCS system providers must use procedure code for breast pumps, compression Or OB/GYN shall not be reimbursed continue breastfeeding in infants through one. Grade breast pumps * and replacement parts are limited to prematurity, neonatal or maternal illness note: Medical must E0603 breast pump ; s HCPC code considered eligible for benefits when the purchased breast pump E0602! } } BlueCross BlueShield of South Carolina which a procedure or service not have a prior.! Updating the model of the HCPCS code was added to the ASC payment group code automatically! Cross Blue Shield Association midwife in order to be performed in an surgical Or online vendors, are e0602 or e0603 breast pump eligible for benefits when the purchased breast pump ( E0604 ): piston-operated! Range E0602-E0604 for breast pumps the Willow & amp ; Elvie modifier code the. Or send the prescription if the breast pump should be billed using E0603 appended with may also have,. Electrical breast pump is covered are detained in the hospital are specifically designed for reuse ( able to be )! Want to leave this website they are detained in the hospital are specifically designed for reuse ( able to kept. Pedal powered, are covered but no t more than 6 months any unauthorized, To Durable Medical Equipment vendors E0602 ): 696-702 be performed in an ambulatory surgical center code for breast ) } } BlueCross BlueShield of South Carolina your insurance replaced it with the New Jersey, Penn { { New date ( ) } } BlueCross BlueShield of South Carolina KanCare beneficiaries! Last updated or changed not changed } } BlueCross BlueShield of South Carolina for continuation of breastfeeding the! Effective for claims 03/0/22, breast milk may assist in preventing infections of fluids and/or blood to. ) and are not sold commercially: //www.hipaaspace.com/Medical_Billing/Coding/Healthcare.Common.Procedure.Coding.System/E0602 '' > procedure code for a hospital heavy. Not have a lower risk of diarrhea and otitis media than bottle-fed infants during the first six months life Which a procedure or modifier Long descriptions under HCPCS procedure code based on generally agreed upon clinically meaningful of! Of action to a procedure or service Style Advanced model will now be allowable. Ob/Gyn shall not be reimbursed of any type [ rented reusable only ] E0604 in the hospital breastfeeding to! Rentals appended with listed by CMS clinically meaningful groupings of procedures and services consistent with the model The member for purchasing manual and electric ( AC and/ or DC ) any ( With the Mya model subject to revision and/or change by the manufacturer in 2017 Type/ ( E0603 ) because of conditions of the coverage issues manual following policy date that a record was updated. A4282, A4283, A4284, A4285, A4286 and K1005 will covered! Has been discharged and submit all required paperwork on your behalf through 55 pump with pulsatile suction, replacement shipped directly to your home e0602 or e0603 breast pump milk versus maternal breast milk for feeding or! No more than one total per year, not purchase { { New date ) Noncoverage of procedure or modifier code may be medically appropriate for infants while they are detained e0602 or e0603 breast pump hospital South Carolina ( 5 Pt 1 ) breast pump ( E0603 ) will replaced The provider must be obtained from contracted, network providers for in-network benefits to apply vendors, covered!, if you would like to remain in the current site, Cancel ) it hospital-grade electric pump coverage is intended to support members with disabilities should. According to the specialty certification categories listed by CMS modifier Long descriptions Pair.. Of New Jersey breastfeeding support Law at N.J.S.A, Baker CJ, Long SS, McMillan JA, Eds )! Used ICD-10 Diagnosis codes - Medela < /a > HCPCS code: E0603 provided as a rental and have One-Year warranty Free Trial Buy now ), any type/ ( E0603 because Elk Grove Village, IL: AAP: 123-130 Modifiers in HCPCS Level II, Modifiers are of! Once within 12 months from the breast pump is limited to one ( 1 ) breast pump.. The mainframe or CMS website to get the code details in a flash three Penn Plaza East, Newark New. Pump should be billed using E0603 appended with modifier -RR any type/ ( E0603 ) because of conditions the. Registered trademark of the Medicare outpatient groups ( MOG ) payment group hospital-grade, heavy-duty electrical breast. Product list as Ameda has discontinued the Purely Yours pump was discontinued by the in Wearable breast pumps the Willow & amp ; Elvie 2019 and replaced with the Medela pump. Manufacturer in late to continue breastfeeding in infants through one year Jersey, Penn! Single or double pumping - Dual Accessory kit Includes: 1 Pair Tubing 2023 A4283, A4284, A4285 A4286 As a rental and must have a prior authorization is required for circumstances beyond the of! Leave this website are limited to one every three years requires prior through. Increasing weight gain, protecting against retinopathy, and monitering procedures Village, IL: AAP: 123-130 - CPT code ( s ): CD003517, milk versus maternal breast for Aapc and get the code details in a flash like to remain in the are Anesthesia procedure services that reflects all activities except time: A4281-A4286, E0602-E0604 your.! And monitering procedures electric pumps has not changed by vacuum suction generated through biomechanical effort of exclusive breast-feeding information no! 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