As we outlined in the April 2023 issue of Insights and Updates for Providers, Point32Health provides coverage for breastfeeding supplies including disposable collection and storage bags for breast milk 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. (Coverage of breast milk storage bags for Tufts Health Together members have a quantity limit of 120 bags per month or 360 bags for three months, in alignment with MassHealth’s policy.)
Coding update: HCPCS K1005 replaced by A4287
We want to share an update to make sure our providers are aware of a coding change for breast milk storage bags, in an effort to prevent claim denials and any unnecessary administrative burden. At the time of the previous announcement, the most appropriate HCPCS code for breast milk storage bags was HCPCS K1005; however, the Centers for Medicare and Medicaid Services recently issued the more permanent HCPCS code A4287 to replace the now-deleted K1005. Going forward, please use code A4287; claims for breast milk storage bags submitted with K1005 will be denied, in accordance with our typical policy regarding new and deleted CPT and HCPCS codes.
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.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Ryan Francis, Stephen Wong,