Provider Tips - Breast Pumps

Postpartum breastfeeding support and equipment are covered benefits for DHMP mothers of newborns. A fully covered standard breast pump can be ordered through DHMP’s preferred vendor and purchased through Rocky Mountain Medical Equipment (RMME), without prior authorization.  

The breast pump allowance is $150 per pregnancy and will cover a standard model: Medela Pump In Style Advanced Starter Set (Item # 101035077). If the member selects a breast pump with a higher value than the allowance, then the member will pay the price difference directly to the vendor.

To receive a breast pump:

• The member must be at or beyond 28 weeks of pregnancy.
• Member’s doctor must submit a breast pump order directly to vendor. The order can be faxed to RMME at 303-806-8030.
• The member can pick up their breast pump at Rocky Mountain Medical Equipment or have it shipped directly to them.
• Rocky Mountain Medical Equipment will bill DHMP directly.

Breast Pumps for Mothers of Newborns

Breast pumps are a covered benefit for all Colorado Medicaid enrollees. Both manual (CPT Code E0602) and double-electric (CPT Code E0603) breastfeeding pumps are now covered as early as 28 weeks into pregnancy and at any time during the postpartum period.

Prior authorization is not required when:

• Ordered through our *Preferred Vendors
• 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 receive a breast pump:

• The member must be at or beyond 28 weeks of pregnancy or any time during the postpartum period.
• Member’s doctor must submit an order for the breast pump directly to vendor.

Preferred Medicaid 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

For more information, visit Colorado Department of Health Care Policy & Financing

Breast pumps are a covered benefit for all Colorado CHP+ enrollees. Both manual (CPT Code E0602) and double-electric (CPT Code E0603) breastfeeding pumps are now covered as early as 28 weeks into pregnancy and 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 receive a breast pump: 

• The member must be at or beyond 28 weeks of pregnancy or at any time during the postpartum period
• Member’s doctor must submit an order for the breast pump directly to vendor 

For more information, visit Colorado Department of Health Care Policy & Financing

Breast pumps are a covered benefit. Both manual (CPT Code E0602) and double-electric (CPT Code E0603) breastfeeding pumps are now covered as early as 28 weeks into pregnancy and at any time during the postpartum period.

Prior authorization is not required when:

• Ordered through our *Preferred Vendors
• 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 receive a breast pump:

• The member must be at or beyond 28 weeks of Pregnancy and at any time during the postpartum period
• Member’s doctor must submit an order for the breast pump directly to vendor

Preferred Medicare Vendors:

*Shield Healthcare - Phone: 866-304-7160, Fax: 469-443-9701
*Edgepark Medical Supplies - Phone:  888-394-5375, Fax: 303-405-6842