CG-DME-35 Electric Breast Pumps

This policy addresses coverage for electric breast pumps (standard non-hospital grade and heavy-duty hospital-grade). A standard pump is medically necessary with documentation of ongoing breastfeeding; a hospital-grade pump is medically necessary when the breastfeeding infant is hospitalized, has a medical/congenital condition that interferes with breastfeeding, or when the lactating individual cannot express sufficient milk after a trial of manual, battery-powered, or standard electric pumps; electric pumps are not covered without ongoing breastfeeding, and hospital-grade pumps are not covered when these criteria are not met.

"A standard, non-hospital grade, electric breast pump is consideredmedically necessarywhen there is documentation of ongoing breastfeeding."

Sign up to see full coverage criteria, indications, and limitations.