(a) Services billed by a contracted IBCLC are only covered when performed in the IBCLC's office setting, patient's home, or other confidential outpatient setting. Payment for inpatient services provided by a Lactation Consultant is included in the hospital's per diem rate.
(b) No separate reimbursement will be made to a facility.
(c) Services are not to duplicate any basic breastfeeding education/training a member may have received through another program such as WIC or the Children's First Program and services must be problem focused.
(d) Services provided by a contracted IBCLC must be provided face-to-face and in an individual setting.
(e) Reimbursement is limited to not more than 6 sessions per pregnancy and must be objectively documented as medically necessary.