Childbirth and Breastfeeding Support Demonstration: Claims and Reimbursement

Breastfeeding Support Services (Lactation)

Individual Lactation Consulting

• CPT^® code 99401 – 15 minutes
• CPT code 99402 – 30 minutes
• CPT code 99403 – 45 minutes
• CPT code 99404 – 60 minutes

Group Lactation Consulting

• CPT code 99411 – 30 minutes
• CPT code 99412 – 60 minutes

If rendered via telehealth, include the appropriate modifier (GT or 95)

*Services limited to six visits total

Antepartum and Postpartum

• CPT code 99509
• Six visits total
• Support is untimed and is per single birth event
• Place of service is limited to residence/home (POS-12)

Continuous Labor Support

• CPT code 59899
• Reimbursement is 15 x CPT code 99509
• Support is untimed and is per single birth event
• Care is not covered at military hospitals or clinics
• Place of service is limited to:
  • Hospital (POS-21)
  • Birthing center (POS- 22)
  • Home (POS- 12)

Please note:

• Telehealth visits are not covered for doula services
• Certified labor doula services not personally performed will not be reimbursed