How To Use HCPCS Code E0603

HCPCS code E0603 describes a specific type of breast pump, namely an electric pump that can be powered by alternating current (AC) or direct current (DC). This code is used to identify and bill for the rental or purchase of an electric breast pump for the purpose of expressing breast milk. In this article, we will delve into the details of HCPCS code E0603, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS E0603?

HCPCS code E0603 is used to identify an electric breast pump, which is a device that helps lactating individuals express breast milk. This code specifically refers to electric breast pumps that can be powered by both AC and DC sources. It is important to note that this code is not applicable to manual breast pumps or other types of breast pump devices.

2. Official Description

The official description of HCPCS code E0603 is “Breast pump, electric (AC and/or DC), any type.” The short description for this code is “Enteral supp not otherwise c.” This description accurately represents the purpose and function of an electric breast pump.

3. Procedure

1. Before using an electric breast pump, the individual should ensure that the pump is clean and sterilized according to the manufacturer’s instructions.
2. Next, the individual should position themselves comfortably and securely, ensuring that the breast pump is properly aligned with the nipple.
3. The electric breast pump should be turned on, and the suction level should be adjusted to the individual’s comfort level.
4. The breast pump will create a vacuum that mimics the sucking action of a nursing baby, stimulating the let-down reflex and encouraging the flow of breast milk.
5. The individual should continue pumping until they have expressed an adequate amount of breast milk or until they feel comfortable.
6. After each use, the breast pump should be disassembled and cleaned thoroughly to maintain hygiene and prevent contamination.

4. When to use HCPCS code E0603

HCPCS code E0603 should be used when billing for the rental or purchase of an electric breast pump. This code is typically used in situations where the individual requires assistance in expressing breast milk, such as when they are unable to breastfeed directly or need to store breast milk for future use. It is important to follow the specific guidelines and eligibility criteria set forth by insurance providers or Medicare to ensure proper reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E0603, healthcare providers should ensure that the following documentation requirements are met:

• A prescription or order from a healthcare provider specifying the need for an electric breast pump
• Documentation supporting the medical necessity of the electric breast pump
• Proof of rental or purchase of the electric breast pump
• Any additional documentation required by the insurance provider or Medicare

Providers should also follow the specific billing guidelines set forth by the insurance provider or Medicare to ensure proper reimbursement for the service or supply.

6. Historical Information and Code Maintenance

HCPCS code E0603 was added to the Healthcare Common Procedure Coding System on January 01, 1985. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to note that this code has an effective date of January 01, 1996, and has been in use for several years without significant changes or revisions.

7. Medicare and Insurance Coverage

HCPCS code E0603 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Providers should consult the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions regarding coverage and reimbursement for HCPCS code E0603.

8. Examples

Here are five examples of scenarios where HCPCS code E0603 may be billed:

1. A lactating individual with a medical condition that prevents them from breastfeeding directly requires an electric breast pump to express breast milk for their infant’s feeding.
2. A working mother needs to express breast milk during her work hours and requires an electric breast pump to facilitate this process.
3. An individual with a low milk supply needs to stimulate milk production and opts to use an electric breast pump under the guidance of a healthcare provider.
4. A lactating individual is experiencing engorgement and discomfort and requires an electric breast pump to relieve the symptoms.
5. A lactating individual is planning to travel and needs to express and store breast milk for their infant’s feeding during the trip.