We’re expanding our existing breast pump preventive service to include a hospital-grade breast pump, CPT code E0604, as of May 1, 2017. This will affect your patients with ConnectiCare commercial plans. You'll need to seek preauthorization approval before you can prescribe it to your commercial patients.
If we preauthorize the hospital-grade breast pump, your female patient will have no out-of-pocket costs as long as the following guidelines are followed:
Date of service: on or after May 1, 2017
Provider: participating in ConnectiCare network
Procedure code: E0604
Frequency: one per 10 rolling months
Age Band: All
If the above guidelines are not followed, the in-network durable medical equipment cost-share will apply. If an out-of-network provider provides the breast pump, the patient will need to pay the out-of-network durable medical equipment cost-share.