Prior Authorization : Home Health Equipment

Breast Pumps

Prior Authorization for Rentals

PA is required if rental of a breast pump (E0604) exceeds 60 days. This 60-day period includes the initial 30-day rental (E0604, modifier "KH").

PA for Purchases

ForwardHealth covers the purchase of a maximum of three breast pumps per member with up to one breast pump per year 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.

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

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