Or. Admin. R. 410-122-0250

Current through Register Vol. 63, No. 8, August 1, 2024

Section 410-122-0250 - Breast Pumps

(1) Indications and limitations of coverage and medical appropriateness:

(a) The Division may cover a breast pump for postpartum women when a pump is necessary to establish or maintain milk production in order to maximize availability of breast milk to the baby;

(b) For cases in which there is a medical indication for breast pumps, the pumps shall be supplied whenever possible within 24 hours to allow for continued milk production;

(c) A breast pump shall not be provided until a need is determined following birth;

(d) A breast pump shall not be provided if it is known that mother is using a substance that is contraindicated while breastfeeding and does not plan to stop its use;

(e) Reimbursement for a single-user electric breast pump (E0603) includes all parts necessary for pumping. A separate kit is not needed or separately reimbursable;

(f) The following services are not covered:

(A) Accessories;

(B) An electric breast pump for the comfort and convenience of the mother;

(C) Supplemental Nutrition System (SNS);

(D) Heavy duty, hospital grade breast pumps;

(E) Replacement parts.

(2) Medical records which support conditions of coverage as specified in this rule are met must be on file with the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider and made available to the Division on request.

(3) Procedure Codes:

(a) E0602 - Breast pump, manual, any type - the Division shall purchase;

(b) E0603 - Breast pump, electric (AC and/or DC), any type:

Or. Admin. R. 410-122-0250

HR 10-1992, f. & cert. ef. 4-1-92; HR 9-1993 f. & cert. ef. 4-1-93; HR 17-1996, f. & cert. ef. 8-1-96; OMAP 11-1998, f. & cert. ef. 4-1-98; OMAP 1-2000, f. 3-31-00, cert. ef. 4-1-00; OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00; OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 8-2002, f. & cert. ef. 4-1-02; OMAP 47-2002, f. & cert. ef. 10-1-02; OMAP 44-2004, f. & cert. ef. 7-1-04; DMAP 17-2008, f. 6-13-08, cert. ef. 7-1-08; DMAP 101-2023, amend filed 12/29/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: ORS 414.065