Breast pumps for mothers of newborns
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Defines the breast pump benefit for pregnant or postpartum members of Denver Health Medical Plan (Elevate Health Plans and Employer Group plans), including eligibility, $150 allowance per pregnancy, ordering, and vendor billing.
No material clinical or coverage changes in this revision.
Coverage Criteria
Primary coverage criteria
Coverage is provided when the following conditions are met:
ALL of the following
- Member is pregnant or postpartum and enrolled in DHMP Elevate Health Plans (Exchange and CO Option) or Employer Group plans
- Member must be at or beyond 28 weeks of pregnancy
- A physician must submit a breast pump order for the member
- A $150 allowance per pregnancy covers a standard breast pump; member pays cost difference for higher-value pumps
- Pump may be picked up at preferred providers (AdaptHealth or Bili Blanket) or shipped directly; preferred providers will bill the plan directly
Allowance and Coding
| No codes listed |
Provider Order & Billing Actions
Order and billing process
A physician must submit a breast pump order on behalf of the member; preferred vendors (AdaptHealth or Bili Blanket) will bill Denver Health Medical Plan directly for the pump.
- Member pick-up available at preferred providers (AdaptHealth or Bili Blanket) or option for direct shipping
- Preferred providers bill the health plan directly
Timing eligibility
Members are eligible to receive a breast pump only once they are at or beyond 28 weeks of pregnancy; a physician-submitted order is required before fulfillment.
- Eligibility: member must be at or beyond 28 weeks of pregnancy
- Requirement: doctor must submit a breast pump order for the member
Definitions
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