February 8, 2013
All Blue Cross and Blue Shield of Kansas Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Coverage of Breast Pumps and Breast Pump Supplies
This newsletter provides information on the coverage of breast pumps and breast pump supplies for various group plans.
The State of Kansas (SOK) expanded the preventive benefit for breast pumps for employees covered under their group health plan. Effective January 1, 2013, the SOK health plan covers electric breast pumps E0603 and E0604 and the manual pump E0602. The SOK plan will also cover breast pump supplies including A4281, A4282, A4284 and A4286.
The Federal Employee Program (FEP) will only cover a breast pump (manual or electric) when purchased at CVS Pharmacy.
Breast pumps are typically not covered for local BCBSKS members who are covered under a grandfathered health plan.
Local BCBSKS plans only allow the purchase of a manual pump as being covered and do not allow the purchase price of the manual pump to be applied towards the purchase of an electric pump. If a local BCBSKS member purchases an electric breast pump it will be denied as non-covered. Local BCBSKS plans do not cover breast pump supplies. A Limited Patient Waiver is not required in order to bill the patient.
If a hospital supplies a breast pump to a patient and the hospital does not have a DME (Durable Medical Equipment) number, then the preventive benefit for a breast pump for a member enrolled in a non-grandfathered health plan is not covered as a preventive benefit. Manual breast pumps are covered when purchased from a licensed durable medical equipment supplier. Hospitals that are also licensed as a durable medical equipment (DME) supplier may request a DME provider contract with BCBSKS. To do so, please contact Provider Network Services at 1-800-432-3587, opt 3.
The above guidelines apply only to non-grandfather plans. For grandfathered plans, the patient is responsible for the charge of the breast pump.
If you have questions regarding this newsletter, please contact your BCBSKS Provider Representative.