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Breast Pump Prescription Information ICD-10 Codes

Page history last edited by Nicole Yonke 2 years, 3 months ago


Double Electric Breast Pump E0603    - Supply Code for pump


Type of breast pump:

Many women prefer the Spectra S1 or S2 breastpump. Women can contact their insurance to see who their insurance is contracted with for medical supplies.  If HME in ABQ is the only supplier, than they have to get a Medela because this is the only pump HME carries.  

Women with United, BCBS, Aetna, Molina insurances are contracted with Edgepark and can order a breast pump through them. 



Possible ICD-10 codes for pump


P92.01 Bilious vomiting of newborn

P92.09 Other vomiting of newborn

P92.1 Regurgitation and rumination of newborn

P92.2 Slow feeding of newborn

P92.3 Underfeeding of newborn

P92.5 Neonatal difficulty in feeding at breast

P92.8 Other feeding problems of newborn

P92.9 Feeding problem of newborn, unspecified

R11.10 Vomiting, unspecified (>28 days old)

R11.12 Projectile vomiting (>28 days old)

R11.14 Bilious vomiting (>28 days old)



P59.0 Neonatal jaundice associated with preterm delivery

P59.3 Neonatal jaundice from breast milk inhibitor

P59.8 Neonatal jaundice from other specified causes

P59.9 Neonatal jaundice, unspecified


Weight and hydration

P74.1 Dehydration of newborn

P74.2 Disturbances of sodium balance of newborn

P74.3 Disturbances of potassium balance of newborn

P92.6 Failure to thrive in newborn

R62.51 Failure to thrive in child over 28 days old

R63.4 Abnormal weight loss

R63.5 Abnormal weight gain

R63.6 Underweight


Infant distress

R68.11 Excessive crying of infant (baby)

R68.12 Fussy infant (baby)

R10.83 Colic


GI issues

R19.4 Change in bowel habit

R19.5 Other fecal abnormalities

R19.7 Diarrhea, unspecified

R19.8 Other specified symptoms and signs involving the digestive system and abdomen



Q38.1 Ankyloglossia

Q38.5 Congenital malformations of palate (high arched palate)


Mother^ ICD-10-CM*

B37.89 Breast & Nipple issues

L01.00  Candidiasis, breast or nipple

O91.02 Impetigo, unspecified

O91.03  Infection of nipple associated with the puerperium

O91.13  Infection of nipple associated with lactation

O91.23 Abscess of breast associated with lactation/Mastitis purulent

O92.03 Nonpurulent mastitis associated with lactation

O92.13 Retracted nipple associated with lactation

Q83.8 Cracked nipple associated with lactation

R20.3 Other congenital malformations of breast (ectopic or axillary breast tissue)

G47.23 Hyperesthesia (burning) Constitutional

O92.3 Fatigue Lactation

O92.4 Agalactia

O92.5  Hypogalactia

O92.6 Suppressed lactation

O92.79 Unspecified disorders of lactation

Z39.1 Galactocele (Other disorders of lactation)

B37.89 Candidiasis, nipple or breast

091.12 Abscess of breast

091.22 Non-purulent Mastitis, Blocked Milk Duct

092.03 Retracted Nipple

092.13 Cracked Nipple

092.29 Engorgement of Breasts

092.29 Sore Nipple

092.3 Failure of Lactation, Agalactia

092.5 Suppressed Lactation

092.79 Other disorders of lactation, Delayed lactation

092.6 Galactorrhea – overproductive milk supply

L01.00 Impetigo (staph) nipple


Cleft Lip Palate Codes 

Q35.1 Cleft hard palate

Q35.3 Cleft soft palate

Q35.5 Cleft hard palate with cleft soft palate

Q35.9 Cleft palate, unspecified

Q36.0 Cleft lip, bilateral

Q36.1 Cleft lip, median

Q36.9 Cleft lip, unilateral

Q37.0 Cleft hard palate with bilateral cleft lip

Q37.1 Cleft hard palate with unilateral cleft lip

Q37.2 Cleft soft palate with bilateral cleft lip

Q37.3 Cleft soft palate with unilateral cleft lip 3 Medical Necessity Guidelines: Breast Pumps

Q37.4 Cleft hard and soft palate with bilateral cleft lip

Q37.5 Cleft hard and soft palate with unilateral cleft lip

Q37.8 Unspecified cleft palate with bilateral cleft lip

Q37.9 Unspecified cleft palate with unilateral cleft lip

Q38.0 Congenital malformations of lips, not elsewhere classified

Q38.2 Macroglossia

Q38.3 Other congenital malformations of tongue

Q38.4 Congenital malformations of salivary glands and ducts

Q38.6 Other congenital malformations of mouth

Q38.7 Congenital pharyngeal pouch

Q38.8 Other congenital malformations of pharynx




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