Breastfeeding, lactation consultation MediCal billing codes

MediCal Billing Codes for Breastfeeding Services

Lactation Consultation

Health Insurance	Breastfeeding Benefit	Diagnosis CPT-4	Billing Code CPT-4	Reimbursement
Medi-Cal CPSP CHMC	Postpartum Health Education Nutrition Psychosocial	V242 Postpartum Related Services	Z6414 Z6208	1 hour $30.32 per hour
Managed Care MediCal Fee for Service	Office Visit: New patient	V242 Postpartum Related Services	99212
Commercial	Office Visit: New Patient	V242 Postpartum Related Services	99212 Established Patient 99201 New Patient - Brief OV	Based on contract: 50%-80%

Breast Pumps Rentals

Health Insurance	Diagnosis CPT-4	Billing Code	Reimbursement Allowed
MediCal: Fee for Service	V242	X2992-Y1	$2.74 daily / $50.00 Monthly
MANAGED CARE /HMO’s	V242	X2992-Y1	$2.74 daily / $50.00 Monthly
Commercial / Private	V242	X299-Y1	50%-80% depends on Contract

PRESCRIPTION

Requires a prescription (Don’t have to submit-if Pregnancy Related only keep in files.)

Limited to lowest cost

Requires Diagnosis

Length of Service

Breast Pump Purchase of Kit

Lactation Aid

Billing Code

Reimbursement

Breastpump Kit

X2994 -Y7

$12.38

Double Kit

X2994 –Y7

$12.38