Coverage Policy Manual - Arkansas Blue Cross and Blue Shield

Electric Breast Pump (Hospital Grade)

Description:

There is compelling scientific evidence supporting the health benefits of breastfeeding for infant, mother, and society. Breastfeeding reduces infant mortality and morbidity with clear evidence of a continued benefit for exclusivity and duration in the first six months of life as well as evidence of lifetime benefits of reduced asthma, allergic disease, obesity, and to a lesser extent autoimmune and malignant diseases. These benefits extend to the mother with reduced pre-menopausal breast and ovarian cancer, cardiovascular disease, and type 2 diabetes. The benefits to society—the family, health plan, and broad economic measures—include reduced hospitalization, reduced physician visits for a variety of related conditions, and savings estimates in the United States of > $10 billion per year.

Current rates of initiation of breastfeeding in the United States are inadequate: the most recent data from the U.S. Centers for Disease Control and Prevention (2009 births) identifies national breastfeeding initiation rates at 76.9%, duration of any breastfeeding for six months at 47.2% and for one year at 25.5%. There is clearly a significant gap to be bridged to meet the nation’s public health goals for breastfeeding.

A number of professional health care organizations (American Academy of Pediatrics; the American College of Obstetricians and Gynecologists; the American Academy of Family Physicians; the Academy of Breastfeeding Medicine; the American Hospital Association; the Association of Women’s Health, Obstetric and Neonatal Nurses; the National Association of Pediatric Nurse Practitioners; the Academy of Nutrition and Dietetics; the American Public Health Association; the International Lactation Consultant Association; the United States Lactation Consultant Association; The Joint Commission; the Human Milk Banking Association of North America; and the United States Breastfeeding Committee (USBC), endorse successful establishment and maintenance of breastfeeding.

This policy addresses only electric breast pump rentals (the use of “hospital-grade” or “rental-grade” electric pumps) for the initiation and continuation of lactation support when there is a medical condition of the infant and/or mother resulting in separation. Lactation counseling and other supporting measures/devices are addressed in policy #2011019 specific to the benefit structure of the contract and applicability of PPACA mandates.

Policy/
Coverage:

Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria

Electric pump rentals* (‘hospital-grade’ or ‘rental-grade’) meet member benefit certificate primary coverage criteria to support initiation of lactation for mothers and infants who are separated due to illness, or who are unable to feed directly from the breast due to maternal or infant medical complications, congenital anomalies, prematurity, induced lactation, relactation, adoption, or other medical conditions for mother or infant which preclude effective feeding at the breast and prescribed by a physician.

For contracts that do not use primary coverage criteria, electric pump rentals (‘hospital-grade’ or ‘rental-grade’) are covered on a medically necessary basis only, such as to support initiation of lactation for mothers and infants who are separated due to illness, or who are unable to feed directly from the breast due to maternal or infant medical complications, congenital anomalies, prematurity, induced lactation, relactation, adoption, or other medical conditions for mother or infant which preclude effective feeding at the breast and prescribed by a physician.

*Coverage is provided up to six months on a monthly basis. All accessories and supplies are considered part of the monthly rental allowance.

Rationale:

This policy addresses only electric breast pump rentals (the use of “hospital-grade” or “rental-grade”

electric pumps) for the initiation and continuation of lactation support when there is a medical

condition of the infant and/or mother resulting in separation. Lactation counseling and other

supporting measures/devices are addressed in policy #2011019 specific to the benefit structure of the

contract and applicability of PPACA mandates.

2019 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2018. No new literature was identified that would prompt a change in the coverage statement.

2020 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2019. No new literature was identified that would prompt a change in the coverage statement.

2021 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2020. No new literature was identified that would prompt a change in the coverage statement.

2022 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2021. No new literature was identified that would prompt a change in the coverage statement.

2023 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2022. No new literature was identified that would prompt a change in the coverage statement.

2024 Update

Annual policy review completed with a literature search using the MEDLINE database through December 2023. No new literature was identified that would prompt a change in the coverage statement.

CPT/HCPCS:

References:

American Academy of Pediatrics Section on Breastfeeding.(2012) Breastfeeding and the use of human milk (policy statement). Pediatrics; originally published online February 27, 2012; DOI: 10.1542/peds.2011-3552.

American Academy of Pediatrics.(2006) Human milk. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 123-130.

Bartick M, Reinhold A.(2010) The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5):e1048-e1056.

Bartick MC, Stuebe AM, Schwarz EB et al.(2013) Cost analysis of maternal disease associated with suboptimal breastfeeding. Obstet Gynecol. 2013;122(1):111-119.

Cheng PG, Johnson LW, Rosenthal MS.(2012) Sources of education about breastfeeding and breast pump use: what effect do they have on breastfeeding duration? An analysis of the Infant Feeding Practices Survey II. Matern Child Health J. 2012;16(7):1421-1430.

Hayes DK, Prince CB, Espinueva V, et al.(2008) Comparison of manual and electric breast pumps among WIC women returning to work or school in Hawaii. Breastfeed Med. 2008;3(1):3-10.

Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association.