Adding Breastfeeding Support Services to Your Practice

The Verden Group

Find out how adding lactation services can benefit your practice financially and clinically.

Q & A with Susanne Madden, chief operating officer of the National Breastfeeding Center

With the implementation of the Affordable Care Act came the mandate to cover breastfeeding support (and equipment) under preventive care services. This means breastfeeding support is now a covered service and there is no cost-sharing by the patient. This offers a rare opportunity for pediatricians to expand their services, improve their bottom lines and deliver care highly valued by parents.

“But I know nothing about providing lactation services!”

Good point, but lucky for you there are thousands of very well-qualified lactation consultants, many of whom are available to work with you to provide in-house lactation consultations. There are a couple of ways this can work. You could hire a lactation consultant and pay her by the hour for pre-scheduled visits. Or, you can contract with a lactation consultant as an independent entity. With an employee arrangement, you would establish the initial visit with the mom (usually at the newborn visit) and bill the consultant’s services as “incident-to” that visit. In the latter case, you might refer your patients to the independent contractor and rent space and services to her. She would charge patients directly for her services, or if she is a licensed provider, she may bill insurance companies directly for those services.

“Are you suggesting the practice bill for services for the mom?”

I am. At the newborn visit, you examine the baby and bill for that well-child visit. You also counsel the mom by educating her about breastfeeding and determining if there are any issues related to nursing. If there are, you would create a new chart for the mom, and the lactation counseling services provided to her are a separate service and a covered benefit under that mom. If you are concerned about providing services to adults, check with your malpractice carrier. In most cases, carriers have no problem with you providing this level of care for infants’ mothers as it is not procedural in nature and carries very little risk. In terms of getting paid for those services, insurers routinely pay a variety of provider types for breastfeeding services and do not restrict pediatricians from doing so.

“I have a nurse practitioner with lactation training. Can she perform those services?”

Of course, and no doubt that provider would love to put her skills to good use. Instead of incident-to billing being required, the nurse practitioner, as a licensed provider, may already be credentialed and contracted with insurers and would simply bill for lactation services the same way as any other evaluation and management service.

“Okay, but what codes should we use?”

This really depends on who is providing the service and what services are rendered. Typically the initial visit with the mom could be billed using a consultation code (99241-99245), if performed in conjunction with a physician and if the mom was referred by another physician, such as her OB-GYN. If the visit is not referred, but the physician is the one establishing the problem, the visit could be based on time (99202/12-05/15) or billed as preventive counseling (99401-04). If the service was performed by a non-licensed provider, then use preventive counseling codes 99401-04 or 96150-55. The 99401-4 codes are the most widely recognized by payers.

“Sounds good. So what’s the downside?”

There really isn’t one. Helping moms breastfeed more effectively is a win for everyone, and being able to receive those services from a trusted pediatric office is a great community builder for your practice. Attention needs to be paid to finding the right lactation consultant for the job, but once you successfully incorporate breastfeeding services into your practice you will find it a welcome addition for your patients and your bottom line.

Susanne Madden, MBA, CEC, is chief operating officer of the National Breastfeeding Center, a consulting firm centered on delivering comprehensive breastfeeding solutions to employers, hospitals and healthcare providers. She is also the founder and CEO of The Verden Group, which helps practices navigate through the increasingly complex business of healthcare. She can be reached at