Lactation Consultations
Defines medical necessity, provider eligibility, and coverage for lactation consultation services for women planning to breastfeed or who are breastfeeding; applies to CareFirst members and network providers.
No material clinical or coverage changes in this revision.
Coverage Criteria for Lactation Consultations
Medical necessity / Preventive coverage
Covered when the following broad condition is met:
Covered as a preventive service per policy and applicable federal preventive service provisions.
Specific contract provisions, restrictions, and exclusions may supersede this policy. Coverage for lactation consultations can vary by member contract and line of business, so providers must verify the member’s contract benefits before applying this policy. The member contract takes precedence over the clinical criteria in this policy; confirm any applicable local, state, or federal coverage requirements that may modify coverage determinations.
Coding and Modifiers
| -GT | HCPCS modifier for interactive audio and video telecommunication systems |
| -95 | CPT modifier for synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system |
Provider Actions, Billing & Authorization
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.