Prior Authorization : Home Health Equipment

Breast Pumps

Prior Authorization for Rentals

PA is required if rental of a breast pump (E0604) exceeds 30 days. The KX modifier must be used for this initial 30-day rental period.

PA for Purchases

ForwardHealth covers the purchase of a maximum of three breast pumps per member with up to one breast pump per year of breastfeeding from the date of equipment delivery without PA for HCPCS procedure codes E0602 and E0603.

Note: The member's initial and subsequent breast pumps do not need to be the same type of breast pump; they may be a combination of manual and electric breast pumps.

PA is required for reimbursement of additional breast pumps. Rental pumps are not included in the three, maximum, allowable pumps.

An exception is that PA is required for HCPCS procedure codes E0602 and E0603 for the following POS for the purchase of one or more breast pumps:

• 31 (Skilled Nursing Facility)
• 32 (Nursing Facility)
• 54 (Intermediate Care Facility/Individuals with Intellectual Disabilities)