Most health plans now cover comprehensive lactation support and counseling as a preventive service without application of a deductible, co-payment, or coinsurance (ie, out-of-pocket cost to the patient) as required by the Patient Protection and Affordable Care Act. That coverage applies as long as the provider of service is in network with the patient’s health plan and the health plan is required to cover essential benefits (only a small number are not). However, how each health plan has interpreted the requirement to pay for breastfeeding support may or may not lead to additional pediatric practice revenue. In this article, we will review lactation counseling as a preventive service and not as an evaluation and management (E/M) service related to a feeding problem requiring medical management. Physicians and other qualified health care professionals (QHPs) addressing feeding problems may report these services with E/M service codes (eg, 99213).

Coding and payment...

You do not currently have access to this content.