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Johns Hopkins Health Plans

Updates to Breast Pump Device Policies for USFHP Members

Johns Hopkins Health Plans has applied updates and clarifications to the breast pump device policies for Johns Hopkins US Family Health Plan (USFHP) members. Beginning April 12, 2019:

Electric Breast Pump (E0603)/ Standard/Manual Breast Pump (E0602)Hospital Grade Pumps (E0604)Hospital Grade Pumps (E0604)
  • Effective for dates of service on or after April 12, 2019: One electric or manual breast pump is covered per birth event (birth or adoption) beginning at the 27th week of pregnancy (third trimester) or birth of a child should the birth occur earlier than 27 weeks.
  • Pumps may be purchased from an in-network provider or any retail store or pharmacy. However, any charges above the maximum allowable charge are not covered and will be the responsibility of the member.
  • Preauthorization required. Hospital grade pumps are only covered for premature infants (born less than 37 weeks and requiring hospitalization).
  • Use of hospital grade pumps is covered while the premature infant remains hospitalized during the immediate postpartum period.
  • Provider can submit clinical documentation to Medical Review at 410-762-5205.
  • Continued use of a hospital-grade breast pump may be covered after the premature infant is discharged and if medically necessary
  • Physician should submit additional clinical documentation to Medical Review at 410-762-5205

Breast Pump Policy Reminders

  • A prescription from an authorized provider is required for breast pumps and equipment.
  • Breast pump kits, which are specific to each manufacturer, are covered. These kits provide the necessary supplies to pump from both breasts simultaneously.
  • Lactation counseling (99401-99404)
    - Services must be rendered by a TRICARE authorized provider
    - No cost shares are associated with lactation counseling
    - Up to 6 outpatient lactation counseling session are covered per birth event.
  • Excluded items include:
    - Breast pump batteries, battery powered adapters, battery packs
    - Regular baby bottles, nipples, caps and lids
    - Travel bags and other carrying accessories
    - Cleaning supplies
    - Baby weight scales
    - Garments and other products that allow hands free pump operation
    - Ice packs, labels, labeling lids
    - Nursing bras, bra pads
    - OTC creams and ointments
    - Breast pumps with “luxury or deluxe” features such as smart phone connectivity, Bluetooth features, rechargeable batteries, luxury tote bags, and car adapters. Members may elect to purchase these items and pay the difference between the TRICARE allowable amount and the actual cost of the item.