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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.7 Breast Pumps

2.2.7
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.
The following procedure codes for replacement parts are benefits of Texas Medicaid: A4281, A4282, A4283, A4284, A4285, and A4286.
Breast pumps are also available through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.