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Denver Health Medical Plan (DHMP) Breast Pump Benefits
Breastfeeding plays a protective role in the health of both babies and moms. It can give your baby health benefits that may last a lifetime. Pregnant or postpartum members of all DHMP plans are entitled to receive a breast pump as a benefit of your health insurance coverage.
A fully covered standard breast pump can be ordered and purchased through Rocky Mountain Medical Equipment (RMME), without prior authorization. The commercial product breast pump allowance is $150 per pregnancy and will cover standard model Medela Pump In Style Advanced Starter Set (Item # 101035077). If you select a breast pump with a higher value than the allowance, then you will pay the price difference directly to the vendor.
To get a breast pump:
- You must be at or beyond 28 weeks of pregnancy
- Your doctor must fax a breast pump order directly to RMME at 303-806-8030
- You can pick up your breast pump at Rocky Mountain Medical Equipment or have it shipped directly to you
- Rocky Mountain Medical Equipment will bill DHMP directly
Breast pumps are a covered benefit for all Colorado Medicaid enrollees. Both manual and double-electric breastfeeding pumps are now covered as early as 28 weeks into pregnancy or at any time during the postpartum period.
A prior authorization is NOT REQUIRED when:
- Ordered through the following Preferred Vendors
Shield Healthcare (Phone: 866-304-7160, Fax: 469-443-9701)
Byram Healthcare (Phone: 800-873-8385, Fax: 303-935-0718)
Edgepark Medical Supplies (Phone: 888-394-5375, Fax: 303-405-6842) - Breast pump is under $500
- Purchased (NU) modifier
A prior authorization IS REQUIRED when:
- Vendor is not a Preferred Vendor
- Breast pump is over $500
- Rented (RR) modifier
To get a breast pump:
- You must be at or beyond 28 weeks of pregnancy or at any time during the postpartum period
- Your doctor must submit an order for the breast pump directly to vendor
Breast pumps are a covered benefit for all Colorado CHP+ enrollees. Both manual and double-electric breastfeeding pumps are now covered as early as 28 weeks into pregnancy or at any time during the postpartum period.
A prior authorization IS REQUIRED for:
- All requests, as CHP+ currently has no Preferred Vendors
- Breast pumps over $500
- Rented (RR) modifier
To get a breast pump:
- You must be at or beyond 28 weeks of pregnancy or at any time during the postpartum period
- Your doctor must submit an order for the breast pump directly to vendor
Breast pumps are a covered benefit for all Medicare enrollees. Both manual and double-electric breastfeeding pumps are now covered as early as 28 weeks into pregnancy or at any time during the postpartum period.
A prior authorization is NOT REQUIRED when:
- Ordered through the following Preferred Vendors
Shield Healthcare (Phone: 866-304-7160, Fax: 469-443-9701)
Edgepark Medical Supplies (Phone: 888-394-5375, Fax: 303-405-6842) - Breast pump is under $500
- Purchased (NU) modifier
A prior authorization IS REQUIRED when:
- Vendor is not a Preferred Vendor
- Breast pump is over $500
- Rented (RR) modifier
To get a breast pump:
- You must be at or beyond 28 weeks of Pregnancy or at any time during the postpartum period
- Your doctor must submit an order for the breast pump directly to vendor
Benefit Questions? Email Health Plan Services for answers to your benefit questions, or contact us by phone.