TMPPM 2010 > Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook > Texas Medicaid (Title XIX) Home Health Services > Services/Benefits, Limitations and Prior Authorization > Breast Pumps

   
 

1.2.7 Breast Pumps

A manual or non-hospital-grade electric breast pump may be considered for purchase only with the appropriate documentation supporting medical necessity. The purchase of a breast pump is limited to one every three years. Providers must use procedure code E0602 or E0603 when billing for the purchase of a manual or non-hospital-grade electronic breast pump. A hospital-grade breast pump (procedure code E0604) may be considered for rental, not purchase. Rental of a breast pump is not time-limited. If more than one type of breast pump is billed on the same day by the same provider, only one will be reimbursed.

To facilitate a determination of medical necessity and avoid unnecessary denials, the physician must provide correct and complete information, including accurate medical necessity of the equipment and/or supplies requested.

Breast pumps are also available through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).


Texas Medicaid & Healthcare Partnership
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