MedicaidPrior AuthMedium impact
Newsletter Vol. 31, No.13
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, Pediatrics·Medical Policy
Effective date
Apr 5, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare updated breastfeeding equipment coverage criteria effective April 5, 2021. Double electric breast pumps (E0603) no longer require prior authorization except for hands-free models, while multi-user hospital grade pumps (E0604) still require prior authorization for rental.
Action Required
Immediately: Update billing system to remove prior authorization requirements for standard double electric breast pumps (E0603). Maintain prior authorization for hands-free models (E0603 with SC modifier) and hospital grade pumps (E0604). Add coverage for breast pump supplies codes A4281-A4286 and K1005 without prior auth, but require prior auth for A9900 (hands-free bra). Ensure delivery timeframes are met: 72 hours prenatal, 24-48 hours postpartum for single-user pumps, 12 hours for multi-user pumps.