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LDH Breast Pump Coverage Changes Effective March 1, 2024 (IB 24-7)

Date: 03/28/24

Louisiana Healthcare Connections is sharing updates made for Electric Breast pump coverage made on March 27, 2024. Effective  for dates of service on or after March 1, 2024,  several changes were implemented for the coverage of breast pumps, including the addition of a new Electric Breast Pump Request Form. In addition, coverage will be extended to allow electric breast pumps to be received by expectant mothers at 32 weeks gestational age, who meet the criteria and intend to breastfeed their infant.

Required documentation changes for electric breast pumps are outlined in bold below:

  • A prescription from the prescribing physician for the electric pump; 
  • Documentation of education/training on breastfeeding by the prescribing physician, licensed breastfeeding practitioner, or healthcare professional;
  • Documentation that Louisiana Medicaid has not purchased a breast pump within the past three years for the same delivery; and 
  • A completed Electric Breast Pump Request Form signed by the prescribing physician and the mother or her authorized representative.

NOTE: Single, manual and hospital-grade breast pumps are still not covered.

The new Electric Breast Pump Request Form is fillable via PDF download and is located on www.lamedicaid.com under “Forms, Files, and User Manuals.” Durable Medical Equipment providers should submit the completed form with the claim for medical review.

Questions regarding Medicaid Fee-for-Service claims should be directed to Gainwell Technologies Provider Relations at (800) 473‐2783 or (225) 924‐5040.

Providers with questions regarding managed care claims can contact their dedicated Provider Engagement Specialist or Provider Services at (866) 595-8133.