Is Lactation Consultant Covered By Insurance?

Did you know that breastfeeding services are required to be covered by most health insurance plans? Continue reading to learn how to get your lactation consultant compensated.

Can you bill for lactation services?

Lactation services do not have their own CPT codes. This means that lactation consultants who are able to bill insurance (i.e. practitioners who are licensed in another speciality) must utilize more generic CPT codes for new or returning patients, such as evaluation and management codes. To achieve optimum payment, these codes must be utilized with attention and caution: Â

Evaluation and Management of an Established Patient at a Physician’s Office or Clinic:

S9443, which denotes a lactation class with a non-physician provider, is the only Level II HCPCS code available to IBCLCs.

Billing evaluation and management CPT codes that end in 4 or 5, such as 99xx4 or 99xx5, should be avoided by IBCLCs. This is because the intricacy and evaluation of body systems required by these CPT codes is unlikely to be satisfied by one IBCLC visit; these CPT codes demand the examination of 8+ bodily parts or systems. Furthermore, these visits are used to assess high-risk conditions and necessitate a thorough assessment of data and patient history. As an IBCLC, using these codes is a red flag for insurance companies, and it could lead to an audit.

You must follow the â3 Râs rule to enhance your chances of receiving compensation for lactation consultation services.

This means you’ll need a reference from your patient’s primary care physician, and it should be in your hands before the visit. After that, you should give care and report to the referring provider.

Are lactation consultants free?

Lactation consultants offer guidance and hands-on assistance with all aspects of nursing. They can assist new mothers with situating the infant, latch issues, and night feedings at first. Even after a mother has established breastfeeding, a lactation consultant can assist her with issues such as too much or too little milk, transitioning to work, and learning to pump. If your peer counselor is unable to address your breastfeeding question, a lactation consultant may be the next person to contact.

International Board Certified Lactation Consultants and licensed nurses provide skilled assistance at WIC Lactation Support Centers. All moms are welcome to use their services, which are free. Call the Texas Lactation Support Hotline at 855-550-6667 to find a center near you.

Do you provide lactation support in Texas? To be added to our directory, please fill out this form.

Is a lactation consultant worth it?

Lactation consultants can provide comfort at a potentially stressful period by answering questions, providing guidance, and assisting with the resolution of breastfeeding issues. Even if you’re an experienced mom, having a lactation consultant weigh in on feeding concerns can be beneficial.

Can an Ibclc bill insurance?

Some IBCLCs can bill according to their experience working in health care settings, and these services will be covered by insurance at standard rates. As a physician, a registered nurse, a nurse practitioner, a physician assistant, a licensed nutritionist, a therapist, or another type of licensed provider, for example.

How do lactation consultants get paid?

To determine competitive yet fair fees, private practice lactation consultants should examine how much other lactation consultants in their region charge. The key factors deciding your hourly rate are local demand, experience level, and overhead expenditures, such as monthly office rent or gas if you’re a traveling consultant. Keep in mind that your time is valuable. Consider how much time you’ll spend going to, preparing for, and following up after each session when determining your rate. In a one-hour session, how many hours of labor will be factored in?

What is the CPT code for lactation consultation?

Lactation consultations (98960) are not separately paid and are considered part of the E & M service when performed concurrently with an E&M visit.

What do lactation consultants look for?

It is quite tough to obtain the IBCLC (International Board Certified Lactation Consultant) certification. It’s a monument to the expertise and dedication these consultants have invested in perfecting their skills. “Registered Lactation Consultants” are IBCLC lactation consultants. They work with mothers and newborns for thousands of hours. They must learn about child development as well as anatomy and physiology.

When it comes to managing nursing, all of their wisdom comes in helpful.

Find Someone You’re Comfortable With

Many mothers discover that their patience and, more importantly, their confidence decrease during the early stages of breastfeeding. Find a lactation consultant with whom you feel at ease and who will guide you through the process of learning to breastfeed.

Interviewing people is an important part of choosing someone with whom you feel comfortable. Before you hire a lactation consultant, don’t be hesitant to make a few phone calls and speak with her.

Ask for Referrals

Breastfeeding support groups can be found on Facebook in many locations and hospital systems. Connect with other women in your community and ask for candid feedback. Make it crystal clear what you expect from your lactation consultant. Inquire about consultants who can help you with your needs.

When should you seek a lactation consultant?

A lactation consultant is a health care provider who focuses on breastfeeding (chestfeeding). Lactation consultants have specific training and certification in order to provide support, advise, and direction to mothers who choose to breastfeed their children. Lactation consultants can help with nipples that hurt, milk supply issues, breastfeeding postures, and other typical nursing issues.

Lactation consultants are typically required during your baby’s first few weeks of life, when he or she is still learning to feed from the breast. Lactation consultants can assist anyone, including first-time parents, surrogate moms, and parents who have breastfed many children. You can see a lactation consultant while you’re still pregnant, after you’ve given birth, or after you’ve been breastfeeding for a few months.

Breastfeeding is a personal choice, but studies suggest that issues like sore nipples and a lack of milk production play a role in a person’s decision to cease breastfeeding. A board-certified lactation consultant is educated to work with newborns and their parents to address feeding problems and increase a parent’s chances of nursing for as long as they want.

How does someone become a certified lactation consultant?

Most nurses, midwives, and doctors have had breastfeeding training and can assist you, especially after birth. Lactation specialists and lactation counselors are some of the professionals who go through training. It’s fine to get nursing advice from any of these people, but a board-certified lactation consultant is someone who has earned a specific qualification.

Lactation consultants who fulfill the demanding standards and pass the exam are certified by the International Board of Lactation Consultant Examiners (IBLCE). After their name, an International Board Certified Lactation Consultant may use the letters IBCLC or RLC. Complete IBLC:

This is the most well-known and well-respected lactation consultant credential.

How can a lactation consultant help me?

Breastfeeding can be emotionally and physically demanding. Being a source of emotional support and encouragement is sometimes the best characteristic of a lactation consultant. The first few weeks after your baby is born are critical for establishing breastfeeding. Your lactation consultant can help you and your baby have a longer and more effective nursing experience.

What will I learn from a lactation consultant?

A lactation consultant is a professional who has been professionally trained and accredited to assist you with any issues or concerns you may have about breastfeeding your baby. They can reassure you and help you troubleshoot specific problems. The following are some of the things you might anticipate to learn from your lactation consultant:

What can I expect from my appointment with a lactation consultant?

A lactation consultant works with you to determine your nursing objectives and assists you in developing a plan, as well as answering any questions you may have. Lactation consultants are most effective when they can feel your breasts and nipples and observe how your baby latches. Virtual consultations, on the other hand, continue to be successful for certain people.

Lactation consultants are on staff at some hospitals, but not at others. Talk to your nurse or healthcare provider if you’re not sure if your hospital sends a lactation consultant to your room after you give birth. You can hire a private lactation consultant to visit you during your hospital stay if your hospital or birthing center does not have one on staff. Labor and delivery nurses are also informed and helpful when it comes to nursing and can provide support until a lactation consultant arrives.

Every hospital, labor and delivery center, and lactation consultant is unique. However, there are a few things you can anticipate from your consultation with a lactation consultant.

  • Within the first few days after giving birth, someone will come to see you. This period is essential for establishing breastfeeding and gaining weight for your kid.
  • Examine your medical history, pregnancy, delivery, and other vital details concerning your child’s health.
  • Pay close attention to how your baby clings to your nipple while you breastfeed. During feeding, they will observe how your baby suckles, swallows, and breathes.
  • Give advice on how to position yourself for nursing and how to get more comfortable with it.
  • Assist you in using your breast pump. This isn’t always practical, especially if you go to the hospital to see a lactation consultant. Your flange, the plastic portion that fits over your nipple, will be examined by a lactation specialist. The amount of milk you pump can be affected by a bad fit.
  • Answer any questions you may have, as well as troubleshoot any concerns that are specific to you and your kid.
  • Teach you how to tell if your kid is getting enough breastmilk and growing properly. This could include things like counting poopy and wet diapers or weighing your kid before and after feedings on a scale.

How much does it cost to see a lactation consultant?

The cost of seeing a lactation consultant varies depending on your location, the services you require, and the type of insurance you have. A lactation consultant may visit you as part of your care at some hospitals. Other times, mothers require assistance beyond what their insurance covers.

It’s wise to check with your insurance carrier to see if seeing a lactation consultant is covered under your policy. If your lactation consultant works at a hospital or a pediatrician’s office, you should note that because those are more likely to be covered. Preauthorization from your doctor is required by some insurance plans. Insurance coverage for lactation consultants in private practices is less common. Make sure you know what is and isn’t covered so you don’t get caught off guard.

How do I find a lactation consultant?

Lactation consultants are employed by hospitals, birthing facilities, and physicians. They can often come to see you shortly after your kid is born or when you go to see your child’s pediatrician. Lactation consultants are sometimes nurse practitioners who have completed their qualification. Lactation consultants might work for themselves or have a private practice.

If a lactation consultant is on staff or available to you, ask your healthcare physician or pediatrician. You can also look for a consultant in your area on the ILBCE website. In the United States alone, there are thousands of ILBCE-certified consultants. If you intend to make a claim for a lactation consultant through your insurance, you should also contact your insurance provider ahead of time.

What are common questions to ask a lactation consultant?

Before you meet with a lactation consultant, make a list of questions. Some questions may be unique to you and your baby, however the following are some of the most common ones asked of a lactation consultant:

If you’re interviewing a lactation consultant before giving birth, do it in a relaxed setting to evaluate if you and the lactation consultant are a good match. The following are some questions to consider:

Lactation consultants can help you and answer your questions if you decide to nurse your baby. Breastfeeding has its own set of difficulties, but a professional lactation consultant can assist you and your baby with any feeding concerns.

Is it too late to see a lactation consultant?

It’s never too late to seek out a lactation consultant! For example, if you find that you need assistance with nursing after giving birth but don’t have a lactation consultant set up, speak with your healthcare practitioner about locating a lactation consultant as soon as possible.

Breastfeeding can begin as soon as one hour after your baby is delivered. While the nurses can help you with the first few feeds, many hospitals also offer lactation consultants on site or available on call to help new mothers.

Even if you didn’t require support earlier (such as mastitis), you can seek advice from a lactation consultant later if you have problems (such as mastitis).

Can you work for yourself as a lactation consultant?

Those who desire to become International Board Certified Lactation Consultants (IBCLCs) must complete the International Board of Lactation Consultant Examiners’ preparation criteria (IBLCE). Prospective IBCLCs must complete standards for health sciences education, lactation education, and lactation clinical experiences in order to take the IBLCE certification exam.

Prospective IBCLCs must finish 14 courses, including 8 college courses in health sciences disciplines including as biology, human anatomy, human physiology, infant and child growth and development, nutrition, research, sociology, and psychology. In addition, they must take training in CPR, medical documentation, medical terminology, occupational safety, professional ethics, and infectious disease safety precautions. These requirements may be waived for current health care providers such as doctors, nurses, midwives, and physician assistants.

In addition, lactation consultants must complete 90 hours of lactation-specific training. The IBLCE does not accredit any lactation education programs, but it does recommend that you take a course that covers all of the areas covered on the certification exam.

Clinical experience is the third prerequisite for test eligibility. Those who have worked with breastfeeding mothers for 1000 hours in the five years prior to taking the exam do not need to complete any more hours. If this prerequisite is not met, prospective IBCLCs must complete 300 hours of supervised clinical practice with breastfeeding mothers.

Obtaining an IBCLC (International Board Certified Lactation Consultant) certification might assist you in recruiting customers and landing jobs by demonstrating that you have met certain educational and experience requirements. Lactation consultants must now be licensed or registered to practice in the states of Rhode Island, New Mexico, and Georgia. Earning a certification may also allow your consumers to pay for your services using their medical insurance.

You must meet the IBLCE’s (International Board of Lactation Consultant Examiners) standards for health sciences education, lactation-specific education, lactation-specific clinical experience, and adhere to their code of professional behavior to become a certified lactation consultant. You can take the certification exam once you’ve satisfied these requirements. The IBCLC certification is valid for five years, and you can renew it by taking continuing education courses. Every ten years, IBCLCs must retake the certification exam.

IBLCE announced changes to exam eligibility rules in June 2019: the organization will no longer employ the flat-rate formula for calculating clinical hours. Between March 1, 2020, and January 1, 2022, this need will be phased in. In addition, beginning with exam applications for April 2021, five hours of communication skills instruction will be required in addition to 90 hours of lactation teaching. On the IBLCE website, you may find more information on this move.

The time it takes to become a lactation consultant is determined by your prior experience. Current health care professionals may already meet the qualifications for taking the certification exam, while newcomers to the sector can finish a certificate program at a college to meet all of the requirements. Lactation consultant certificate programs typically last one year.

Depending on their region, certified lactation consultants charge $100 to $200 each session or more. Doctors and nurses that include lactation consulting into their existing practice will earn a compensation that falls somewhere in the middle of their profession’s salary range.

In 2013, 76.5 percent of American mothers attempted to breastfeed their infants, up nearly three percentage points from 2007, but still far higher than the 58 percent who attempted breastfeeding in 1985. The US Centers for Disease Control and Prevention is aiming for 81.9 percent of moms to try breastfeeding by 2020, and 25.5 percent of infants to nurse exclusively until they are six months old.

Lactation consultants will become more important as more mothers choose to try breastfeeding and nurse their children for longer periods of time. While lactation consultants are in high demand, those who are also registered nurses should have the best work opportunities, particularly in hospitals.

Lactation consultants who work for themselves can establish a successful private practice and attract more clients by obtaining referrals from previous clients and other health care experts in the area.

Lactation consultants, like doctors and nurses, can improve their careers by obtaining additional education and training and assuming leadership roles in their hospital or practice.

You must market your services and develop relationships in your neighborhood if you want to operate as an independent lactation consultant. Client recommendations might come from health-care professionals such as nurses, doctors, and midwives, therefore it’s critical to create a network of people who can reliably promote your services.

Additional requirements may be necessary beyond a lactation consultant certification if you want to work in a hospital, physician’s office, or lactation center. Lactation consultants who are also registered nurses, for example, are in high demand.

For anyone interested in becoming an IBCLC, the International Lactation Consultant Association and its US counterpart, the United States Lactation Consultant Association (USLCA), are excellent resources. Clinical Lactation is a publication published by the USLCA, and you can read the archives on their website to learn more about the profession and lactation research.