Wiki Outpatient Lactation services at hospital

[jules0024]

Hi,
I am trying to figure out if 99404 can be used to bill for lactation services provided at my hospital as an outpatient service (facility charge vs office). Also can this be billed by the RN providing the lactation services or does a physician need to be present?

Thank you!
Julie

 

[nielynco]

Hi,
I am trying to figure out if 99404 can be used to bill for lactation services provided at my hospital as an outpatient service (facility charge vs office). Also can this be billed by the RN providing the lactation services or does a physician need to be present?

Thank you!
Julie

The Affordable Care Act, which is still in place, states that payers must cover, at no cost to the patient, "comprehensive lactation support and counseling, by a trained provider during pregnancy and / or in the postpartum period, and costs for renting breastfeeding equipment". The problem is the law does not define what comprehensive support means, who qualifies as a trained provider, nor how to bill for it. So basically this is payer dependent. And we also have to know if this is a class, whether the RN is qualified to teach under State regs, etc. For instance 99404 could only be billed by a provider who can be paid directly and is giving individual lactation services for a particular patient. This level of service would not fly if the RN was providing the service, nor if she was teaching more than one patient. Another option (if this RN qualifies under the payer rules as a non-physician provider rather than clinical staff) is 98960 for self management and there is also a S9443 for lactation classes by a non-physician. Again, check with your payers on this. If these classes are associated with the delivery in any way, the facility fee will be bundled for sure, but the provider might be able to bill.