A breast pump is a device used to extract milk from the breast of a lactating mother for infant feeding when the mother cannot be present at feeding time or when the infant is too sick or too weak to suck.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person’s unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Coverage is subject to the specific terms of the member’s benefit plan.
Rental of an electric breast pump is eligible for reimbursement when ANY ONE of these criteria is met:
In lieu of an electric breast pump, purchase of a manual breast pump is eligible for benefits when one of the above criteria is met.
Accessories are considered eligible for benefits when the purchased breast pump is eligible for benefits.
When the above criteria are met, breast pumps meet the definition of DME and payment may be made for a breast pump according to the member’s DME benefits.
Breast pumps and accessories not qualifying for coverage in accordance with the above criteria do not meet the definition of durable medical equipment (DME). Therefore, they are not covered under the member’s contract.
The criteria above regarding an electric breast pump, a manual breast pump and accessories does not apply to those groups that follow the Women's Health Federal Mandate effective August 1, 2012.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect BCBSND’s reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.