Women's Preventative Services Update

Breast Pumps and Breastfeeding Supplies Overview

On August 1, 2011 HHS published an amendment to the Preventive Services provision of the Patient Protection and Affordable Health Care Act (known as PPACA or Federal Health Care Reform). The original provision which took effect on September 23, 2010 specified that, at a later date, additional services targeted at women would be added to the list of preventive services that must be covered at zero cost-share. An amendment released on February 15, 2012 specified that these services, referred to as Women’s Preventive Services (WPS), have an effective date of August 1, 2012.

Women’s Preventive Services Covered at No-Cost

The amendment added several services that were not previously included on the list of Preventive Services effective in 2010. These services will be added to plans which currently cover the PPACA Preventive Services:

  • Screening for gestational diabetes.
  • Breastfeeding support, supplies, and counseling
  • Screening and counseling for interpersonal and domestic violence
  • FDA approved contraceptive methods and counseling
    • Includes surgical, prescription, medical and OTC services/products
      Note: Sterilization is considered a contraceptive method. Abortion IS NOT considered a contraceptive method.

Services mentioned in the amendment, but previously included on the list of covered Preventive Services include:

  • Annual well-women visit
  • HPV (Human Papilloma Virus) testing
  • Annual counseling for sexually transmitted infections
  • Annual counseling and screening for HIV (Human Immunodeficiency Virus)

Update on Breastfeeding Supplies

Coverage is provided at zero-cost share to the member for the rental OR purchase of a Manual Breast Pump, for the rental or purchase of an Electric Breast Pump, or the rental only of a Hospital Grade Electric Breast Pump. Breast pumps must be rented or purchased from a CareFirst in-network Durable Medical Equipment (DME) supplier OR certain professional provider types:  General Practitioner, Family Practitioner, OB-GYN and Pediatricians.

Out-of-Network providers/suppliers are not covered at zero-cost share for breastfeeding equipment or supplies.

NOTE: Pumps available for purchase at retail outlets such as Target, Wal-Mart, etc. are not covered under this benefit.

Breastfeeding supplies covered at zero-cost to the member include:

HCPCS Codes

Description

A4281

Tubing for breast pump, replacement

A4282

Adapter for breast pump, replacement

A4283

Cap for breast pump bottle, replacement

A4284

Breast shield and splash protector for use with breast pump, replacement

A4285

Polycarbonate bottle for use with breast pump, replacement

A4286

Locking ring for breast pump, replacement

E0602

Manual Breast Pump (Rental or Purchase)

E0603

Electric Breast Pump (Rental or Purchase)

E0604

Hospital Grade Electric Breast Pump (Rental Only)

Below is a chart of preliminary DME providers of breast pumps and breastfeeding supplies. We do anticipate that additional suppliers will be added to this list:

Provider Name

Phone number

Manual Breast
Pump (E0602)

Electric Breast
Pump (E0603)

Hospital Grade Pump (E0604)

Rent?

Purchase?

Rent?

Purchase?

Rent?

Western Maryland Medical

(301) 729-4280

No

Yes

No

Yes

No

Gregg's Pharmacy

(301) 334-2197

No

Yes

No

No

No

PharmaCare

(301) 777-0202

No

No

No

Yes

No

Medi Rents

(800) 540-7252

No

No

Yes

No

No

Equipped for Life

(301) 714-0200

No

No

Yes

Yes

No

Northern Pharmacy

(410) 254-2055

No

No

No

No

Yes

Citizens Pharmacy Services

(410) 939-4404

No

No

No

Yes

No

Whitesell's Pharmacy

(301) 662-4848

No

No

Yes

Yes

No

Edgepark Medical Supplies

(800) 321-0591

No

Yes

No

Yes

No

New Hampshire Pharmacy

(202) 726-3100

No

No

No

No

Yes