Back to Insights and Updates for ProvidersApril 2023

Coverage updates for breastfeeding equipment and supplies

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Health RITogether

Point32Health provides coverage for breastfeeding supplies including disposable collection and storage bags for breast milk (HCPCS code K1005) for Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, and Tufts Health RITogether members, with a quantity limit of 300 bags per three-month reimbursement period.

This coverage is effective for dates of service on or after Jan. 1, 2023; claims denied between that date and now will be reprocessed through our claims system.

Please note that coverage of breast milk storage bags (HCPCS K1005) for Tufts Health Together (Massachusetts) members have a quantity limit of 120 bags per month or 360 bags for three months, in alignment with MassHealth’s policy.

As a reminder, coverage of breast pumps for pregnant or postpartum members may include manual, electric, or hospital grade breast pumps when medically necessary and obtained from a contracted durable medical equipment provider with a physician’s prescription. It may be medically necessary to obtain a different type of pump than initially obtained.

Members are eligible to receive breast pump replacement parts 90 days after the purchase of the breast pump, and again every 60 days thereafter. While replacement parts represented by codes A4281, A4282, A4284, and A4826 have a limit of one per three months (purchase only), replacement bottles (A4285) and replacement caps for the replacement bottle (A4283) do not have a quantity limit.

For more information, refer to Harvard Pilgrim’s Commercial Non-Covered Services Payment Policy and Breast Pumps Medical Policy, as well as Tufts Health Plan’s Breast Pumps Medical Necessity Guidelines, which have been updated to reflect the coverage of HCPCS code K1005 and provide clarity regarding breast pumps and replacement parts.

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