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Resources

Resources shared here are public information, available without contracting with an insurance company. Some additional information may be available for specific plans, that is only available to providers, billers and staff that have an active contract with an insurance company. In these cases, we may be able to share the information in a one on one training or consulting session, but sharing proprietary information publicly would be a violation of the provider’s contract. If you have specific questions about topics or resources that are not listed here, consider scheduling a training or consulting session!

Keep checking back, we will be adding more resources frequently!

Lactation Billing Resources

Aetna Lactation resources

Aetna's Lactation Consultant coding update (page 7)

Aetna breast pump and breast feeding coverage

Aetna Preventative Services for Women

Aetna State Specific Provider Manual (no lactation specific information, but other important standards for in network providers)

Aetna Provider participation criteria

Lactation consultants

Many Aetna® plans also cover up to six visits with a lactation consultant if you need support with breastfeeding. Your in-network ob/gyn or pediatrician may offer these services through his or her office.

BCBS Lactation resources

BCBS AK Lactation Counseling benefits (2019) See

BCBS AK Premera Preventative Care benefit coverage (page 10)

BCBS AL Preventative Service Benefits (page 2)

BCBS AL Provider access portal (must have a log in to access provider manuals)

BCBS CA Women's Preventative Services Effective 1/1/18 (page 2)

BCBS DE Lactation Counseling Coverage (3/4 down page) When provided by credentialed physicians who can employ lactation consultants or use their nursing staff to provide support.

BCBS IL Lactation Support Services Policy Effective 6/26/25

BCBS KS Preventative Services Guide (page 8)

BCBS MA Lactation Counseling Services PDF

BCBS MI Preventative Services Coverage Guidelines (page 2)

BCBS NC Women's Preventative care (CNM, OB/GYN and Facilities only)

BCBS NC Preventative Services coding guide (page 2)

BCBS NC Prior Auth code lookup

BCBS NC Lactation benefit and provider list

BCBS ND Preventative Health Benefits and Coding (page 16)

BCBS NJ Horizon Breastfeeding policy (NP, PA, CNM or higher credentials only)

BCBS NM Breastfeeding Intervention Policy Effective 4/1/24 (page 7)

BCBS OK Preventative Services Policy Effective 2/1/25 (page 7)

BCBS TN TennCare Lactation guidelines

BCBS TN Commercial Provider Manual 10/1/25 (page 121)

BCBS TX Lactation Support Services Policy Effective 6/26/25

BCBS TX Provider Manual - Submitting Claims

BCBS TX Provider Manual - Claim Forms

BCBS VT telehealth coding S9443 policy Effective 1/1/24 (page 17)

BCBS VT Preventative Care Guide Effective 1/1/24 (page 33)

Anthem preventative Health guidelines 7/1/25

Highmark Women's Preventative Health Services Guidelines 2025 (page 2)

Premera BCBS Preventative Care coverage guidelines (page 10)

Wellmark Breastfeeding benefits Patient resource

Ohio Medicaid Lactation Coverage 12/22/21

Ohio Medicaid telehealth billing guidelines Effective 1/1/25 (page 2)

Cigna Lactation resources

Cigna Preventative Care Services

Cigna Credentialing and Recredentialing

Wildflower Cigna lactation network

Tricare Lactation resources

Tricare Childbirth and Breastfeeding support benefits

Tricare 2025 Changes to Childbirth and Breastfeeding support benefits

Tricare Breastfeeding Counseling benefit outline

Tricare Lactation Taxonomy and Billing codes

Tricare allowable rates tool

UHC Lactation resources

UHC non physician healthcare codes

UHC non physician healthcare professionals billing evaluation and management codes policy

UHC Breastfeeding service and supplies policy (page 41)

UHC Consultation Services Policy 2025

TennCare Lactation guidelines

Wellpoint (Previously Amerigroup) Lactation resources

Frequently used Lactation codes

Using the correct code that matches: services rendered, allowed CPT codes for the particular plan, time spent face to face with the patient, and scope of practice under your license are crucial to obtaining proper reimbursement and protecting yourself from audits and recoups.

Just because an insurance company will pay a certain code, or a combination of codes, does not mean you're in the clear. Insurance companies can perform audits 10 years prior and recoup any codes or combination of codes they deem inappropriate or unnecessary. One major healthcare company recently announced they would be going back 5 years and recouping an education and counseling code that was popular during COVID. Their statement included verbiage: "You are responsible for submission of accurate claims...Accordingly, {insurance company name} may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. ". Their stance is that you as the provider are responsible for understanding the codes you are billing, and only billing what is "appropriate". We have already heard of major insurance companies starting to audit Lactation Consultants nationwide, particularly for the use of E/M codes that are physician only codes.

If you find yourself in an audit or dispute with insurance, sole liability falls on the provider. They don't care if your biller gave you bad information, or if the Facebook group you are part of was mistaken with their suggestions. We always err on the side of caution and provide our clients with straightforward pros and cons of certain billing practices. We would rather keep your safe, than let you bill improperly and possibly suffer the consequences years later.

Most Lactation appropriate timed codes must be used for face to face time with the patient, and not billed concurrently with other codes.

Coding for preventative care - American Academy of Pediatrics 2025

AAPC code definition 98960

AAPC code definition S9443

AAPC code definition 99404

Physician codes

AAPC code definition 99204

AAPC code definition 99214

Incident- to or Supervisory Lactation billing resources

Incident-to, or Supervisory billing, is not a one size fits all fix for your billing needs. Yes, your reimbursement may be higher and you can possibly access more codes, but not every insurance company allows this type of billing, and each State's requirements for a supervising physician are different. It's vital that you understand your State's laws and read your insurance contracts. Some insurance contracts require that your supervising physician be on site with you while you are seeing patients, even if your State laws do not require the supervising physician to be on site. There is a high risk of being flagged for Waste, Fraud and Abuse when billing under a supervising physician. Understand the risks and how to keep yourself safe.

BCBS TN TennCare Lactation guidelines (page 6 and 11-13 of the PowerPoint)

BCBS TN Commercial Provider Manual 10/1/25 (pages 68 & 121)

Behavioral Health Billing Resources