Coverage for breast pumps and lactation support for breastfeeding mothers in New Jersey

October 15, 2020

New Jersey recently passed a law establishing deadlines by which breastfeeding equipment must be supplied to a member following her request. AmeriHealth New Jersey currently covers breast pumps as part of our Preventive Services policy. Going forward, we will work in coordination with our participating Durable Medical Equipment (DME) providers to support breastfeeding mothers with timely delivery of requested equipment.

Breastfeeding equipment

The following equipment is covered:

  • Single-user breast pump. Purchase of one manual or double electric breast pump. Unit will be repaired or replaced if necessary and will not require a prescription, letter of medical necessity, or prior authorization.
  • Multi-user breast pump. Rental of a multi-user (hospital-grade) breast pump on the recommendation of a licensed health care provider. A doctor’s order is required.*
  • Breast pump kits. Purchase of two breast pump kits, appropriate size breast pump flanges or other lactation accessories recommended by a health care provider per birth event.

*Obtaining the order may not delay the provision of the pump.

DME providers must supply members with breast pumps and related equipment within the following time frames:

  • Single-user breast pumps after the child’s birth: within 48 hours of request
  • Single-user breast pumps before the child’s birth: the later of two weeks before the expected due date or 72 hours after requested
  • Multi-user breast pumps: within 12 hours of request

Lactation counseling and consultation services

In addition to covering breast pumps, AmeriHealth New Jersey supports new mothers by covering one-on-one consultation or counseling, or group lactation counseling, performed by individuals who are recognized as an International Board-Certified Lactation Consultant. We also cover lactation counseling by practitioners who are:

  • licensed or certified to perform lactation counseling;
  • health care providers or individuals accredited in another profession and provides breastfeeding education and support services for which that person is licensed, regulated, accredited, or certified; or
  • community-based lactation supporters who have received at least 40 hours of specialty education in breastfeeding or lactation and is working within their scope of practice.

Lactation support services are provided without prior authorization, referral, or cost sharing.