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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2009

Update: Reimbursement for breast pumps

Effective for claims with dates of service beginning August 15, 2009, Harvard Pilgrim will not reimburse for manual breast pumps (billed with HCPCS code E0602). Harvard Pilgrim will reimburse only for an electric breast pump (billed with HCPCS code E0603) or for a hospital grade breast pump, rental only (billed with HCPCS code E0604) when the newborn and mother are separated due to hospitalization, or the newborn has a congenital anomaly that prevents effective breast-feeding. Please also note that breast pumps billed with HCPCS code E0603 or E0604 are reimbursed for covered conditions for a maximum rental period of three months.

The following diagnosis codes correspond to the above-mentioned covered conditions of when the newborn has a congenital anomaly that prevents effective breast-feeding: 749.00-749.04, 749.10-749.14, 749.20-749.25, 750.10-750.19, and 750.21-750.29.

Because there is no diagnosis code that corresponds to the covered condition of when a newborn and mother are separated due to hospitalization, in order to be reimbursed, supporting clinical documentation must be submitted to Harvard Pilgrim on appeal.

For more detailed information, please read Harvard Pilgrim's Durable Medical Equipment Payment Policy and Medical Policy for breast pumps.

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