After reading this document and having some experience with direct provision of personal breast pumps by insurance companies contracting with DME providers, I have this comment:  These "personal pumps" were designed for WORKING mothers with NURSING babies as an adjunct to breastfeeding, not a substitute.  The fact that they may support milk supply for a period of time is wonderful but long-term I have not found them effective for many women.  I wish someone would do a study (or knows of one done) that addresses long-term pumping and milk supply and correlates between the routine and type of pump used from early days and long-term maintenance of supply.  I have seen way too many women who exchange their personal pumps for hospital grade rental pumps such as the Symphony with increases in supply noted after the switch-out.  Every insurance company is going to seek to limit their expense with the ACA.  They will want to reimburse 20 or 30 for a consult, 100 for a pump, etc. It's only natural.  Great for moms to get "free" service.  Not so great for the workers who won't be able to pay their bills, I'm thinking.  How has this worked out for places with all free health care?  Do mothers breastfeed longer and use less formula? 



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Mandy Schaub

Sent: Wednesday, July 18, 2012 9:04 AM

Subject: More Reimbursement Questions



In light of the Affordable Care Act I’m asking some questions.  Specifically IBCLC’s employed in hospital practice that are not advanced practitioners and not working under the umbrella of a physician.  That is how I operate and I feel like that is the greyest area when it comes to reimbursement.  I am not under a physician’s, NP or PA’s umbrella.  I know some of you are NP’s or in physician practices so this is going to be a whole lot easier for you!   I have the 2008 Reimbursement Toolkit.



-Is anyone who is NOT a DME currently billing private insurance for rentals or purchase pumps?  How are you doing that? Check out the link below.  My interpretation of this document is United Health Care (and possibly other insurance carrieers as well) will accept billing for pumps from a hospital directly that is not a DME as of 8-1-12.

 http://www.uhc.com/live/uhc_com/Assets/Documents/Reform_BreastfeedingSupplies.pdf



-Is anyone in a hospital OP setting currently billing private insurance for OP visits?  How are you doing that?



-What codes do I use to bill for outpatient visits?  I see in the toolkit a section that says “Billing for any clinician’s visit based on time”.  Is that really ANY Clinician?  Does that mean me as a non-MD, NP, PA?  Can I use these 99202 or 99212 codes to bill for my OP visits?  I 



 -It has been suggested it may be possible to use the Health and Behavior Assessment and Intervention codes IF the OB were to write a referral at mom’s discharge from the hospital.  I understand to use the HBAI codes the visit has to be on a separate day with a previously diagnosed medical condition.  If we set it up that way would I then use the 96150 codes?



Thanks, Mandy



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