CurrentDelaware Department of Health and Social ServicesPolicy 17-003

Lactation Counseling Services

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This policy governs separately reimbursed, pregnancy-related lactation counseling services under the Delaware Medical Assistance Program when delivered by specified qualified clinicians who are certified lactation consultants.

Policy Summary

PayerDelaware Department of Health and Social Services

PolicyLactation Counseling Services

Policy CodePolicy 17-003

Change TypeNo material change

Effective DateJun 2, 2017

Next Review DateN/A

Key ActionDocument the face-to-face encounter with the mother and child, its duration, required assessments and interventions, community-support information, and evaluation of outcomes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Maximum counseling sessions per child

90 minMaximum session duration

30 minMinimum face-to-face duration

5Eligible clinician types

Covered Lactation Counseling Services

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CurrentDelaware Department of Health and Social ServicesPolicy 17-003

Lactation Counseling Services

Customize your policy alerts

Sign up for Delaware Department of Health and Social Services Policy 17-003 alerts

Get alerted when Policy 17-003 changes without checking for updates manually.

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Policy Summary

PayerDelaware Department of Health and Social Services

PolicyLactation Counseling Services

Policy CodePolicy 17-003

Change TypeNo material change

Effective DateJun 2, 2017

Next Review DateN/A

Key ActionDocument the face-to-face encounter with the mother and child, its duration, required assessments and interventions, community-support information, and evaluation of outcomes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Maximum counseling sessions per child

90 minMaximum session duration

30 minMinimum face-to-face duration

5Eligible clinician types

Covered Lactation Counseling Services

Comprehensive lactation counseling

Lactation counseling services are permitted when all provider and comprehensive-service requirements are met.

Eligible provider and comprehensive counseling requirements

Provider qualification: Service is provided by a Physician, Nurse Practitioner, Physician Assistant, Midwife, or Registered Nurse who is certified as a Certified Lactation Consultant (CLC) or International Board Certified Lactation Consultant (IBCLC).
Comprehensive counseling components
- Face-to-face encounter with the mother and child.minimum 30 minutes
- Assessment: Comprehensive maternal, infant, and feeding assessment related to lactation.
- Interventions include observation of the mother and child during breastfeeding; instruction in positioning techniques and proper latching to the breast; and counseling regarding nutritive suckling and swallowing, milk production and release, frequency of feedings and feeding cues, expression of milk and use of a pump if indicated, assessment of infant nourishment, and reasons to contact a health care provider.
- Community supports: Information on community supports such as Women, Infants, and Children (WIC) is provided.
- Outcome evaluation: Outcomes from interventions are evaluated.

Session and duration limits

Services are limited unless medical necessity supports exceeding the limit.

Utilization limit: There is a limit of five counseling sessions per child, and each session can last up to 90 minutes.5 sessions per child; up to 90 minutes per session

In accordance with Section 1905(r) of the Social Security Act, the service limit may be exceeded based on medical necessity.

Provider Requirements and Denial Risks

Documentation Required

Comprehensive Service Documentation

Document a comprehensive lactation counseling encounter that includes the required face-to-face service, assessments, interventions, community-support information, and outcome evaluation.

Face-to-face encounter with the mother and child lasting at least 30 minutes.
Comprehensive maternal, infant, and feeding assessment related to lactation.
Interventions including observation during breastfeeding; positioning and proper latch instruction; counseling on nutritive suckling and swallowing, milk production and release, feeding frequency and cues, milk expression and pump use when indicated, infant nourishment, and reasons to contact a health care provider.
Information on community supports such as Women, Infants, and Children (WIC).
Evaluation of outcomes from the interventions.

Billing Rule

Provider Qualification Required

Ensure the service is furnished by an eligible clinician who also holds the required lactation certification.

Eligible clinician types: Physician, Nurse Practitioner (NP), Physician Assistant (PA), Midwife (MW), or Registered Nurse (RN).
The clinician must be certified as a Certified Lactation Consultant (CLC) or International Board Certified Lactation Consultant (IBCLC).

Unsupported block type: denial_risk

Lactation Counseling Overview

Lactation counseling services are available as a separately reimbursed, pregnancy-related service under the Delaware Medical Assistance Program. These services provide breastfeeding health education and counseling through a qualified, certified lactation consultant.

Counseling supports breastfeeding, feeding technique, milk production and release, infant nourishment, and recognition of situations requiring contact with a health care provider. Comprehensive services include assessment of the mother, infant, and feeding process; direct observation and instruction; counseling; information about community supports such as WIC; and evaluation of intervention outcomes.

Key Definition

Certified lactation consultant

DefinitionA certified lactation consultant is a clinician recognized under this policy as holding a Certified Lactation Consultant (CLC) or International Board Certified Lactation Consultant (IBCLC) certification.

Eligible clinician typesThe clinician must be a physician, nurse practitioner, physician assistant, midwife, or registered nurse.

Certification requirementThe eligible clinician must also be certified as a CLC or IBCLC to provide covered lactation counseling services.

Policy Summary

PayerDelaware Department of Health and Social Services

PolicyLactation Counseling Services

Policy CodePolicy 17-003

Change TypeNo material change

Effective DateJun 2, 2017

Next Review DateN/A

Key ActionDocument the face-to-face encounter with the mother and child, its duration, required assessments and interventions, community-support information, and evaluation of outcomes.

SourceLink

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