Summary & Overview

HCPCS A4288: Valve for Breast Pump, Replacement

HCPCS Level II code A4288 denotes a replacement valve for a breast pump — a durable medical equipment (DME) component used to maintain or restore pump function for individuals expressing breast milk. Nationally, replacement parts for breast pumps support lactation management, reduce waste by extending device life, and can affect access to essential supplies for breastfeeding parents.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the code, common modifiers associated with DME supplies, typical sites of service, and how payers commonly categorize replacement parts for breast pumps. The publication outlines standard billing considerations, where available, and highlights the operational context for claims processing of replacement valves.

The report provides benchmarks and policy-relevant context for suppliers and billing staff, including typical use cases for replacement valves, coding clarity to support accurate claim submission, and national payer coverage patterns where published. Data not available in the input is noted where applicable. This summary is designed for a national audience of clinicians, DME suppliers, and revenue cycle professionals seeking a practical reference for HCPCS Level II code A4288.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA4288HCPCS Level IIbreast pumpdurable medical equipmentreplacement partlactation supportmedical billingclaims coding

Billing Code Overview

HCPCS Level II code A4288 describes a valve for breast pump, replacement. This item is a replacement component intended to restore or maintain the function of a mechanical or electric breast pump used for expressing breast milk. The service type is durable medical equipment supply / replacement part, and the typical site of service is home use where patients use breast pumps for ongoing lactation support.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A lactating patient requests a replacement valve for a personal or hospital-grade breast pump after noticing decreased suction and milk expression. Typical workflow: the patient contacts a lactation clinic, durable medical equipment supplier, or outpatient pharmacy; the clinician or lactation consultant confirms the pump model and identifies the worn or cracked valve as the cause of reduced performance; the supplier dispenses the replacement valve A4288 or orders it for shipment; documentation includes patient identifiers, pump model, part replaced (A4288), date of issue, and clinical indication such as ongoing breastfeeding support or weaning assistance. Typical site of service: outpatient clinic, lactation consultant office, DME supplier location, or patient’s home when delivered. A common patient scenario: a postpartum patient at two weeks postpartum with engorgement and low milk output due to a degraded pump valve requests a replacement part to restore effective pumping and maintain milk supply.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use if unusually high effort or complexity is documented for procurement, fitting, or customization of the replacement valve beyond standard supply issuance.
`52`	Reduced services	Use if a partial supply or incomplete service was provided relative to expected equipment issuance.
`53`	Discontinued procedure	Use if the provision of the replacement valve was started but discontinued before completion for documented clinical reasons.
`BR`	Birth-related	Use when the supply is related specifically to a birth-related condition per payer rules (where accepted).
`KR`	Replacement of DME part	Use when billing for replacement component of durable medical equipment, indicating the item replaces a broken or worn part.
`NR`	Non-routine supply	Use when the valve is a non-standard or specialized replacement part requiring special handling or sourcing.
`NU`	New equipment	Use when the valve is provided as part of a new device package rather than a standalone replacement.
`RR`	Rental equipment	Use when the valve is provided in conjunction with rental of the breast pump rather than sale.
`UE`	Durable medical equipment unused	Use if the replacement valve is provided but not used or returned to stock per policy documentation.

Taxonomy Code	Specialty	Notes
`251B00000X`	Obstetrics & Gynecology	OB/GYN clinicians coordinate postpartum lactation support and DME prescriptions.
`251E00000X`	Pediatrics	Pediatricians may document breastfeeding issues and recommend pump part replacement for neonatal feeding support.
`367A00000X`	Lactation Consultant	IBCLC clinicians assess pump performance and recommend or order replacement valves.
`332B00000X`	Durable Medical Equipment Supplier	DME suppliers dispense and bill for replacement pump parts such as `A4288`.
`163W00000X`	Family Medicine	Family physicians manage postpartum care and may authorize parts to support breastfeeding.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O91.03`	Nonpurulent mastitis associated with childbirth, left breast	Mastitis can impair milk removal; a functioning pump valve `A4288` supports milk expression during treatment.
`O92.11`	Galactostasis, right breast	Milk stasis may require effective pumping; replacement valve restores pump suction and helps relieve engorgement.
`O92.12`	Galactostasis, left breast	Same as above for the contralateral breast; documentation may support medical necessity of the replacement part.
`Z39.1`	Encounter for care and examination of lactating mother	Routine lactation care visits often include troubleshooting and replacement of pump components like `A4288`.
`Z39.2`	Encounter for routine postpartum follow-up and care	Postpartum follow-up visits may result in ordering replacement parts to support ongoing breastfeeding.
`O91.13`	Nonpurulent mastitis associated with childbirth, bilateral	Bilateral breast conditions increase need for reliable pump function; replacement valves are clinically relevant.
`O91.9`	Unspecified infection of breast associated with childbirth	When infection or inflammation affects breastfeeding, a replacement valve can be part of supportive care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 15 minutes	Used for brief lactation counseling or breastfeeding education provided when issuing a replacement valve.
`99402`	Preventive medicine counseling; approximately 30 minutes	Used for more in-depth lactation consultation during which replacement parts like `A4288` are discussed and ordered.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Used when a clinician documents a postpartum visit that includes evaluation of pump performance and orders the replacement valve.
`E0604`	Breast pump, electric (rental or purchase, per payer rules)	Commonly associated device; valve `A4288` is a replacement component for electric breast pumps billed under this device family.
`99070`	Supplies and materials (except spectacles), noncovered items and supplies; usually used to report items not separately coded	Used in workflows where a supplier bills for replacement parts not covered under other specific codes when payer guidance permits.