Medicare AdvantagePrior AuthMedium impact
Breast Pumps – Hospital Grade
Blue Cross Blue Shield of Rhode Island·RI · OB-GYN, Family Medicine, Pediatrics·Physician / Facility
Effective date
Aug 1, 2022
We identified it
Jun 19, 2026
Summary
Effective August 1, 2022, BCBSRI removed the prior authorization requirement for hospital grade breast pumps (HCPCS E0604) for Medicare Advantage and Commercial plans. The device is now a covered service without requiring pre-approval, but providers must continue following general medical appropriateness guidelines.
Action Required
Immediately: Billing team must update prior authorization workflows to remove pre-approval requirements for HCPCS code E0604 (hospital grade breast pumps) for BCBSRI Medicare Advantage and Commercial plans. Update billing system rules and staff training materials. Ensure providers continue documenting medical appropriateness when ordering these devices as BCBSRI will monitor utilization patterns.