Procedure code for breast pumps?

Amanda041104

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!

lesalia217

oh!  thanks for asking.  i was going to see about this too. 

MrsMoody2006

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

buffalo_buckeye

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

StrawberryAlarmClock

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.

JenGK

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.

MWoodside

You'd need a prescription from your dr & a letter of medical necessity for the ins co to even consider it.