Electric Breast Pump E0603 | 100% – no cost-share | In-Network Provider or contracted Durable Medical Equipment (DME) supplier only | Two per benefit period Coverage is the cost up to the purchase price ($125-$150) |
Hospital Grade Breast Pump E0604 | 100% – no cost-share Rental only (see limit/restriction) | In-Network or contracted DME supplier | Hospital grade pump only available for monthly DME rental. Coverage is up to the purchase price of $1,000 or 12 months whichever comes first. Upon end of coverage, unit must be returned to DME provider. |