W-2 Agencies HMOs and Other Managed Care Programs Wisconsin Medicaid is revising its clinical guidelines and adjusting maximum fees to better reflect costs associated with breast pump starter kits. Breast pump procedure code descriptions will also change. Revisions to the guidelines are listed in bold.
Documentation indicates there is the potential for adequate milk production.
Documentation shows there is a long-term need and planned use of the breast pump to obtain a milk supply for the infant. The recipient is capable of being trained to use the breast pump as indicated by the physician or provider. The provider who supplies the breast pump equipment is required to obtain and maintain on file the physician's orders documenting the clinical requirements of the individual's need for a breast pump. Attachment 1 of this Update is an optional form that can be used to ensure all coverage criteria are addressed in the physician order. Home health agencies.