Update: Electric Breast Pump Covered Benefit
This letter serves as notice that electric breast pumps (E0603) will only be covered for members with a qualifying diagnosis. All providers are to report the device using the baby’s Medicaid ID after discharge when medically necessary.
WellCare Health Plan adheres to the Georgia Department of Community Health (DCH) Electric Breast Pump Benefit as described in the manual for Durable Medical Equipment Services. Providers must append an appropriate diagnosis that aligns with the following criteria outlined in section 1109.3 of the DCH Durable Medical Equipment manual to receive an approval. The mother and/or child must meet at least one of the criteria below.
• Baby has a congenital anomaly that interferes with the mother’s ability to breastfeed (Example: Cleft lip or palate, Down Syndrome, Pierre-Robin Syndrome, Oral deformity)
• Baby has neurological issues (Example: Cerebral or Facial Palsy)
• Mother has long-term conditions that cause sickness or weakness that prevent the ability to breastfeed
• A NICU baby that is discharged home from a prolonged infant hospitalization that requires the use of a hospital grade rental pump
If a claim is not billed under a baby’s Medicaid ID or contain diagnoses do not align with the medical necessity guidelines listed above, the claim will be subject to denial.
WellCare Health Plan encourages and supports breastfeeding. Members with healthy babies should request breast pumps through the Georgia Women, Infants and Children (WIC) program. Eligible members can receive breastfeeding counseling, breast pumps, and other supplies. WIC has local offices across the state. The member can call 1-800-228-9173 to see if they qualify for the program.
If you have any questions, please contact Provider Services at 1-866-231-1821. Our staff is available Monday through Friday from 7:00 AM to 7:00 PM EST.
Thank you for your participation in our network and for your dedication to the health of our members.
Sincerely,
WellCare Health Plans
