2nd Trimester

Procedure code for breast pumps?

Just wondering if anyone knows what a procedure code for a breast pump? I've seen posts that some insurance companies cover or partially cover breast pumps. I tried calling my ins company this morning and they told me that they would need a procedure code to determine if its covered under my policy. So if anyone knows, I would appreciate it!

Re: Procedure code for breast pumps?

  • oh!  thanks for asking.  i was going to see about this too. 
  • You would have to get it from your doctor. Basically what they're saying is if your doctor submits it with a certain code...one that says the pump is an absolute necessity for the health of the baby, they will cover it. I ran into something similar when my insurance tried not to cover an ER visit because it was billed as a normal pregnancy visit (which I had already used my allotted normal visits for the month) instead of an ER visit and I had to have the hosital resubmit it's claim and change the procedure code
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  • Found this on google. ? 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, electric (AC and/or DC), any type [rented reusable only] ICD-9 codes covered if selection criteria are met:: 749.00 - 749.25 Cleft palate and cleft lip 750.0 - 750.19 Tongue tie and other anomalies of tongue 750.21 - 750.29 Other specified anomalies of mouth and pharynx
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  • This is probably the same as the "diagnosis code" I'd assume.  Your OB will be familiar with the policy.  My ins only covers it in extreme situation. Sad
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  • You'll need both the CPT code (procedure code) and ICD9 code (diagnosis code) from your doctor.  Many insurance companies will only cover breast pumps when prescribed in conjunction with a particular problem the baby is having (cleft palate, for instance, which would be the diagnosis). 

    For instance, my insurance will not cover a Level II ultrasound (which has a specific CPT code) unless is it billed with a ICD9 diagnosis code indicating that there are signs of abnormalities that necessitate a higher ultrasound level.  If it is billed with the IC9 code indicating that I'm having a routine, normal pregnancy, the claim for the Level II ultrasound will be denied.

    Zachary, 8.31.2007 * * * Adam, 3.24.2010

  • You'd need a prescription from your dr & a letter of medical necessity for the ins co to even consider it. 
    BFP#2 12/6/11, EDD 8/13/12. Missed M/C found at 13w4d, HB gone. D&C 2/13/12. Lilypie Second Birthday tickers Daisypath Anniversary Years Ticker
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