• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Free Resources
    • Free Resources Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • E/M Changes
    • How Physician Services Are Paid
    • In Person E/M
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management

Coding and reimbursement for lactation services

Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly.

  • Is lactation counseling separately billable or considered part of the obstetrical package?
  • What if the patient sees the physician and a lactation counselor? Can both be billed?
  • Do payers recognize the services of a lactation counselor?
  • What CPT or HCPCS codes can we use to be reimbursed?
  • Are there diagnosis requirements?

The answers to these questions will depend on who the patient has for an insurer. Some payers have policies that allow for the work of a non-physician to be billed separately if all requirements are met. Other payers do not recognize the services provided by a lactation counselor as a covered service. This puts the responsibility on the clinic or provider to understand the policies of each of the payers they contract with to make sure that they comply with the rules.

The best first step is to call the insurer and speak with a provider representative to help you locate the applicable policy or policies for the services you plan to provide.

Lactation counseling can fall into the category preventive care, routine obstetric care or problem or illness related. This information will guide coverage and coding decisions.

With the Affordable Care Act (ACA) law enacted in 2016, Breastfeeding Support, supplies and counseling were listed as services considered to be preventive care.

Preventive care services are for visits not related to a problem or illness. Preventive care services are to be provided at no additional cost to the patient, meaning that health benefit plans are required to provide these benefits and are prohibited from cost-sharing. However, it is left to individual health benefit plans to determine who may provide the service, how frequently and in what setting.

To help you get answers to the questions posed at the beginning of the article, we will provide some helpful resources:

Login to read the rest of this article


Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

click here!

Last revised December 9, 2021 - Betsy Nicoletti
Tags: screening and counseling for behavioral conditions

CMS split/shared services

Questions about CMS split/shared services rule changes? In this quick reference sheet you'll learn what these services are, who can bill them, and where. And, information about "substantive portion" and selecting level of service for time vs. key components..

Get Resource

Recommended Resource

You’ve coded it, but you still have to fight to get paid! We’ve partnered with Elizabeth Woodcock to give you the tools and strategies you need.

Find them here!

Latest Intel

CPT Coding for Obstetrical and Gynecological Procedures | Webinar

Who Runs the World? GIRLS!!: CPT Coding for … Read More...

Payment denials for unspecified codes

From the day coders got their first glimpse at … Read More...

Behavioral health coding compliance

Compliance Lessons from the OIG In March 2022, … Read More...

Acute, uncomplicated vs. acute with systemic symptoms

Question: What is the difference between an … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management category of service CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_E/M services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets E/M rule changes FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding ICD-10 coding level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers other E/M services Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth
  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright 2022, CodingIntel
Privacy Policy