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Home > For Providers > Manage Care > Health Education and Disease Management > Breastfeeding Support and Breast Pump Benefit

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Breastfeeding Support and Breast Pump Benefit

The Alliance provides access to breastfeeding education, support and referrals for new mothers.

The Alliance covers up to two visits with a home health agency nurse and two hours with an International Board Certified Lactation Consultant (IBCLC) outside of the hospital stay (inpatient lactation education is included in the hospital per-diem). For a current list of approved providers, please refer to the International Board Certified Lactation Consultant and Breast Pump Provider Vendor List.

Members are eligible for a free breast pump if either:

  • Mother or baby has medical issues that prevent nursing at the breast.
  • Mother is returning to work or school and wants to continue breastfeeding.

The table below shares information on benefits, authorization and billing codes for Alliance member breastfeeding support. You can also view printable versions of the Breastfeeding Support and Breast Pump Benefit Description and the International Board Certified Lactation Consultants and Breast Pump Vendor List.

Breastfeeding Support and Breast Pump Benefits Information
Benefit Description Authorization Billing Codes
Lactation consultant visit
  • Restricted to Alliance-approved providers (see Alliance-Approved Lactation Consultant Providers table below for list).
  • Provided by an International Board Certified Lactation Consultant (IBCLC).
  • Addresses complex problems, such as mastitis, suppressed lactation, etc.
  • IBCLC does not need a Medi-Cal provider number to bill. Invoice or bill on CMS1500 or UB04 claim form (available at office supply stores).
No RAF or TAR required for 4 units per 12-month period for a total of two (2) hours.

Referred by doctor, mid-level professional, certified nurse midwife, Alliance staff or self-referral.

CPT: Z5023* with a qualifying ICD-10 diagnoses code from categories O91, O92, P92, Z39 or Dx Code R63.3

Reimbursed at $45.74 per 30-minute unit.

Limited to two (2) 30-minute units per visit.

Initial nurse home visit, postpartum
  • Restricted to home health agencies only with a Medi-Cal billing number.
  • For all births covered by the Alliance, mother may receive an initial nurse home visit after delivery.
  • Addresses common problems.
  • Provided by a trained home visit nurse.
  • Direct skilled nursing services by a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes.
  • Follow-up of early OB discharge. For OB service, not a typical home health service.
A TAR is required, one (1) visit per day, except when services are in conjunction with the initial or six-month case evaluation. Includes supplies used as part of the treatment visit.

No limit on the number of daily visits.

No TAR is required, one (1) service day limit.

National HCPCS code G0300 must be billed with revenue code 0551, skilled nursing/visit. Standard reimbursement at $74.86.

National CPT-4 code 99501, home visit for postnatal assessment and follow-up care or 99502, home visit for newborn care and assessment must be billed with revenue code 0580.

Standard reimbursement at $74.86.

Follow-up nurse home visit for identified breastfeeding problems
  • Restricted to home health agencies only with a Medi-Cal billing number.
  • For mothers who have never breastfed and mothers who want to breastfeed but were previously unable to nurse longer than one month.
  • Addresses common problems.
  • Provided by a trained home visit nurse.
No RAF or TAR required for one (1) visit per 12-month period. Home visit nurse will order at initial home visit, if needed. CPT: Z5021* with a qualifying ICD-10.

Dx Code Z39.1.

Reimbursed at $80.

Personal use of breast pump, purchase
  • For mothers separated from baby, certain medical conditions of baby, or if mother is returning to work or school.

Note:

  • Claims follow “by report” requirements. Attach pricing/catalog page.
  • The Alliance will cover any type of breast pump, not just the lowest cost item.
  • IBCLCs do not need a Medi-Cal provider number to bill for the Alliance breastfeeding support benefits.
No referral or authorization request required.*

Ordered by physician, mid-level professional, certified nurse midwife or IBCLC.

Reimbursement to contracted pharmacies, contracted medical supply vendors or approved lactation consultants only.

CPT: E0603 with a qualifying ICD-10 Dx code Z39.1.

Modifier: NU.

Reimbursement at 80% of MSRP or up to $250, whichever is less.

Hospital grade electric breast pump, daily rental Per Alliance Policy 405-2214 - Breastfeeding Support Benefits, Standards and Promotion Program, daily rental of a hospital grade breast pump will be covered when medically necessary. These conditions include, but are not limited to:

  • Mother continues to be treated for postpartum complications that preclude direct nursing at the breast.
  • Mother has a medical condition that requires treatment of her breast milk before infant feeding.
  • Mother is receiving chemotherapy or other therapy with pharmaceutical agents that render her breast milk unsuitable for infant feeding.
  • Infant continues in hospital after mother is discharged.
  • Infant has congenital dysfunction or neonatal condition that precludes effective direct nursing at the breast (physician should refer infant to California Children’s Services).
Authorization request required only if rental is to continue beyond 60 days.

Authorization request must include documentation of medical need, infant’s date of birth and requested duration of rental.

Approved authorization requests will specify a time limit based on medical condition.

Ordered by physician, mid-level professional, certified nurse midwife or IBCLC.

CPT: E0604 with a qualifying ICD-10 Dx Code Z39.1.

Modifier: RR.

Reimbursed at $2.72 per day (incl. tax). May be billed in conjunction with E0602 (see below).

When previously paid rental charges equal the documented retail purchase price of the rented item, the item is considered to have been purchased and no further reimbursement to the provider will be made [per Title 22. Section 51321(C)].

Kit for hospital grade pump or manual breast pump, purchase
  • Personal kit for use with rented hospital grade pump, per requirements above.
  • May also be ordered for use with a multi-user pump borrowed from WIC.
No referral or authorization request required.

Ordered by physician, mid-level professional, midwife or IBCLC.

CPT: E0602**  with a qualifying ICD-10 Dx Code Z39.1.

Modifier: NU.

Reimbursed at retail rate plus tax if pricing attached, or at estimated amount if no pricing sent. Kit may be billed in conjunction with E0604.

Miscellaneous medical supplies for lactation management and support, purchase Includes nipple shields and creams.

Does not include furniture, pillows or bedding.

Prescribed by doctor, mid-level professional or midwife. No referral or authorization request required for these supplies. CPT: A9900 with a qualifying ICD-10 Dx code Z39.1.

Modifier: NU.

Reimbursed at retail plus tax if pricing attached, or at estimated amount if no pricing sent.

Replacement breast pump supplies for lactation management and support, purchase Includes:

  • Tubing for breast pump.
  • Adapter for breast pump.
  • Breast pump bottle and cap.
  • Breast shield, splash protector and locking ring for use with breast pump.
  • Polycarbonate bottle for use with breast pump.
A TAR must be submitted, justifying the need for any breast pump supply that needs to be replaced and may not be reimbursed when provided within the same month of service as breast pump codes E0602 and E0603. CPT: A4281, A4282, A4283, A4284, A4285 and A4286 with a qualifying ICD-10 Dx code Z39.1.

Modifier: NU.

Reimbursed at retail plus tax if pricing attached, or at estimated amount if no pricing sent.

*Alliance members are eligible for one personal use breast pump every three years. If there is a need for a second breast pump during the three-year period, an authorization request must be submitted with documentation stating the reason that the original pump cannot be used.

**Per Medi-Cal manual, E0602 may be used to bill either a manual breast pump or a breast pump kit.

Alliance-Approved Breast Pump Vendors

Any Durable Medical Equipment (DME) vendors with a Medi-Cal provider number may provide a breast pump to eligible Alliance members who are breastfeeding and meet medical necessity or who are returning to work or school. No prescription is required and only one breast pump will be dispensed every three years. Members must have a written note or letter from a physician, midlevel professional, certified nurse midwife or IBCLC. Written notes for breast pumps must include the following member information:

  • Alliance ID number.
  • Address.
  • Phone number.
  • Delivery date.

Members may also call the Alliance Health Education Line at 800-700-3874, ext. 5580 for additional information on breastfeeding and how to access a breast pump. The following list of vendors routinely provides breast pumps for Alliance members.

Alliance-Approved Breast Pump Vendor List
Santa Cruz County
Horsnyder Pharmacy

1226 Soquel Ave., Santa Cruz, CA 95062

Phone: 831-458-1400

Fax: 831-458-1401

Electronic Fax: 831-534-7052

 

Watsonville Pharmacy

1433 Freedom Blvd., Watsonville, CA 95076

Phone: 831-728-1818

Fax: 831-728-8678

Monterey County
Robin Didoszak, IBCLC

Expressed Luv

Phone: 831-869-9308

*Lactation/Pump Consultations

Merced County
Merced Medical Supply

1827 Canal St., Merced, CA 95340 Phone: 209-722-3832

Fax: 209-722-2779

 

Emily Bernard, BSPsy, IBCLC Before & After Baby

2239 Bailey Ave., Merced, CA 95341

Cell: 209-631-8511

Fax: 209-379-4218

*Lactation/Pump Consultations

DME Vendor List Serving all 3 Counties/Mail Order Only
Advance Home Medical*

Phone: 800-230-4761

Direct Line: 909-569-9013

Fax: 888-518-7568

 

*Upon request, may supply battery pack.

Simply Mama*

Phone: 844-470-7867

Fax: 855-552-1461

*Upon request, may supply battery pack or car adapter.

Shield Healthcare

Phone: 800-675-8842, select option 1.

Santa Cruz County Fax: 925-256-1639

Monterey and Merced counties Fax:

559-449-4257

International Board Certified Lactation Consultants

IBCLCs provide comprehensive, clinical breastfeeding management and support when medically necessary. IBCLCs do not need a Medi-Cal provider number to bill for services. A provider referral is not necessary. Members may self-refer for lactation services.

The following providers are currently approved to provide lactation consultation for Alliance members when medically necessary.

If you are an IBCLC who is interested in providing services to Alliance members, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 to apply.

Alliance-Approved Lactation Consultant Providers
Santa Cruz County
Willow Merchant, RN, IBCLC*

Phone: 650-862-9336

*Santa Cruz Mountains only - Boulder Creek, Ben Lomond, Felton and Bonny Doon (home visits).

Sutter Maternity Surgery Center - Lactation Center*

2900 Chanticleer Ave., Santa Cruz, CA 95065

Phone:
831-477-2229

Fax:
831-477-2221

*Lactation consultations and drop-in breastfeeding support groups.

Salud Para La Gente*

45 Neilson St.,
Watsonville, CA 95076

Phone:
831-728-0222

Fax:
831-707-2777

*Linked members only.

Watsonville Hospital Outpatient Clinic*

75 Neilson St., Watsonville, CA 95076

Phone:
831-768-6204

Fax:
831-625-5521

*Linked members only.

Monterey County
Natividad Medical Center Outpatient Clinic

1441 Constitution Blvd., Salinas, CA 93906

Phone: 831-796-1652

Fax: 831-751-0607

Robin Didoszak, IBCLC*

Expressed Luv

Phone: 831-869-9308

*Lactation/pump consultations

Merced County
Emily Bernard, BSPsy, IBCLC

Before & After Baby

2239 Bailey Ave., Merced, CA 95341

Cell: 209-631-8511

Fax: 209-379-4218

*Lactation/pump consultations

Billing

The services and equipment listed may be billed under either a mother or baby who is a current Alliance member. Billing limits apply to the mother/baby unit.

Please note that professional services, rental, supplies and durable medical equipment (DME) items cannot be billed to Medi-Cal for an amount greater than what is charged to the general public, per Title XXII.

If education is conducted as a home visit, bill only for education time. Travel time and expenses are not reimbursable.

Approved IBCLCs and DME vendors may bill for listed services and equipment under either mother or baby. Billing limits apply to the mother/baby unit.

Additional Resources Available to Alliance Members (Bilingual English/Spanish)
Service Description How to Access Fees
Breastfeeding Helpline (U.S. Department of Health and Human Services) La Leche League-trained peer counselors offer support for successful breastfeeding. Counselors can help with common breastfeeding questions on issues ranging from latching to pumping and storage. 800-994-9662 Breastfeeding Helpline (U.S. Department of Health and Services)
Comprehensive Perinatal Services Program (CPSP) breastfeeding services
  • Approved CPSP providers offer breastfeeding education, nutrition education, support and referrals for Medi-Cal members only.
  • Services are provided in the antepartum and postpartum period. Services are billed with specific CPSP codes. Providers must be set up in the Alliance system as CPSP providers in order to be reimbursed for these codes.
County Perinatal Services Coordinators:

Santa Cruz County
831-454-5477

Monterey County 831-755-4640

Merced County 209-381-1142

No charge, but members must qualify. Services are billed under CPSP perinatal education, nutrition, psychosocial and health education billing codes.

Medi-Cal members only.

Women, Infants and Children (WIC) program breastfeeding services
  • WIC serves pregnant or breastfeeding women, and children up to age 5.
  • Alliance Medi-Cal members automatically qualify for WIC. Other members may qualify, depending on income.
  • WIC provides breastfeeding classes during and after pregnancy. WIC also provides other support services including breast pump loans and counseling.
  • Women get more WIC benefits if breastfeeding.
Mothers should call WIC directly for enrollment:

Santa Cruz County

Santa Cruz
831-426-3911

Watsonville
831-722-7121

Monterey County

Seaside
831-393-3251

Salinas
831-796-2888

Soledad
831-678-5121

Merced County 888-381-5261

No charge, but members must qualify.

Contact us | Toll free: 800-700-3874

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