Lactation Consultant - pediatrics practice

kkaye4416

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Does anyone know how to bill out for a Lactation Consultant for pediatrics practice? Please if someone could advise I would appreciate it.

Thanks
 
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Is this a nurse? Does he or she have the lactation consult credentials? All of the webinars and education I have found looks like it is pretty payer specific. Some options to check are S9443, 99211, 98960,96150 + HCPC supply codes for the breast pumps and replace parts: E0602, E0603, A4284.
 

ajgibson

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confused

The question we are having, is if we are billing this to the baby or the mother.... and if it is to the mother, will that cause a problem with the supervising physician being a pediatrician? :confused::confused::confused:
 
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Lactation counseling

Did anyone ever find an answer out to billing for a lactation consultant?
From what I have seen, you really must check the policies of the individual payers. The mother is usually the patient and should receive services as a preventive health benefit if the plan is not grandfathered under the ACA. Be aware that some plans are bundling the breastfeeding support to preventive E/M and routine postpartum visits and not really providing benefits for the breastfeeding support. However, some plans very specifically cover the services and list qualifications of the provider of lactation counseling services.

Example: https://www.tricare.mil/CoveredServices/IsItCovered/BreastfeedingCounseling


It's not much help but what I have been able to find. The question of care by the pediatrician is one that is also dependent on each payer's claims adjudication system edits (ie, whether it pairs patient age with physician specialty).

Best wishes,
Cindy
 
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