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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 : Prior Authorization
Breast pumps and replacement parts require prior authorization. The replacement parts may be reimbursed if the client already owns a breast pump device (procedure code E0602 or E0603). The prior authorization request must include documentation of a client-owned device. Additional documentation such as the purchase date, serial number, and purchasing entity of the device may be required. Replacement of the breast pump will be considered when loss or irreparable damage has occurred, with a copy of the police or fire report when appropriate, and with the measures to be taken to prevent reoccurrence. Replacement will not be authorized in situations where the equipment has been abused or neglected by the client, the client’s family, or the caregiver.

Texas Medicaid & Healthcare Partnership
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