Lactation Support Services are Now a Covered Benefit
The Department of Health Care Policy & Financing (HCPF) is implementing a new Colorado law, House Bill HB22-1289, known as “Cover All Coloradans.”
Starting December 1, 2024, Health First Colorado and Child Health Plan Plus (CHP+) members will have access to expanded lactation services as part of Cover All Coloradans.
Starting December 1, 2024, International Board Certified Lactation Consultants (IBCLCs), Certified Lactation Counselors (CLCs), and Certified Lactation Educators (CLEs) can enroll as Health First Colorado providers to provide lactation support services to members.
We are working to establish a robust network of providers. Please utilize the resources below to enroll as a Health First Colorado International Board Certified Lactation Consultant (IBCLC), Certified Lactation Counselor (CLC), or Certified Lactation Educator (CLE).
This page will continue to be updated with the most current information. If you cannot find the information you are looking for, please contact the Reproductive Health team at hcpf_maternalchildhealth@state.co.us.
- What are Lactation Support Services?
Lactation Support Services include training and counseling the breastfeeding (or lactating) member about breastfeeding and human lactation, and providing comprehensive, skilled care and evidence-based information for breastfeeding and human lactation, from pre-conception to weaning.
Lactation support can be in-person or via telehealth in a 1-on-1 or group setting before childbirth and after delivery.
- How does it work?
International Board Certified Lactation Consultants (IBCLCs) with current certification by the International Board of Lactation Consultant Examiners (IBCLE) can enroll in Health First Colorado as a billing individual or individual within a group. If you enroll as a billing individual you can submit claims for yourself and receive payment directly from Health First Colorado. If you enroll as an individual within a group and affiliate with an existing group/clinic, the group/clinic submits claims on your behalf and pays you directly.
Certified Lactation Counselors (CLCs) with current certification by the Academy of Lactation Policy and Practice, Inc. (ALPP) and Certified Lactation Educators (CLEs) with current certification by the Childbirth and Postpartum Professional Association (CAPPA) can enroll as a Health First Colorado provider as an individual within a group. The individual within a group enrollment type is an individual who renders service but does not bill First Health Colorado directly. The individual must be associated with a group/clinic that submits claims on their behalf and the group/clinic pays the CLC/CLE directly.
Certified Professional Midwives (CPMs)/Direct Entry Midwives (DEMs), Certified Midwives (CMs), Certified Nurse Midwives (CNMs), Licensed Physicians (MDs/DOs), Licensed Physician Assistants (PAs), Licensed Advanced Practice Nurses (APNs), and Licensed Registered Nurses (RNs) for whom lactation support services are within their scope of practice, according to state licensing requirements and laws, and who have had training in advanced lactation support should begin reporting lactation support services using HCPCS code S9443. Claims will be accepted for dates of services on and after December 1, 2024.
- Lactation Provider Enrollment
Please refer to the Lactation Provider Enrollment Quick Guide for detailed enrollment steps.
Click on the Provider Enrollment Portal to be guided to the Health First Colorado Lactation Consultant or Lactation Counselor/Educator application. Provider enrollment forms can be found on the Provider Forms web page under the “Provider Enrollment & Update Forms” heading.
Provider enrollment and billing details can be found in the Lactation Support Services billing manual, available in the CMS 1500 section on the Billing Manuals web page.
- Provider Training Materials and Resources
Sign up for training sessions focused on Health First Colorado provider enrollment and billing. All sessions will be held via Zoom webinar. You can find the registration links in the calendar on the Provider Training web page. All training materials can be found below the calendar in the Billing Training – Resources drop-down section. Recordings of the training sessions can also be accessed through the links provided below.
Please find below the links to the training decks:
- Provider Enrollment Training
- Beginner Billing Training for Professional Claims
- Intermediate Billing Training
Visit the Provider Resources web page for quick guides, help with the Provider Web Portal, frequently asked questions, and more.
Frequently Asked Questions
Breast Pump Coverage
Both manual and electric breast pumps are covered. Please refer to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) billing manual for details on breast pump coverage.
Resources and Additional Information
Announcements/Upcoming Meetings
Stay alert for announcements and upcoming meetings.
Meeting Archives
- Lactation Stakeholder Meeting - May 29, 2024
- Lactation Stakeholder Meeting - February 27, 2024
- Lactation Stakeholder Meeting - January 30, 2024
Stay Informed
If you want to be added to the email list for lactation updates, please sign up for the Reproductive Health Newsletter. Updates regarding the Lactation Support Services benefit will be provided as needed.
Contact Information
Questions about policy and coverage may be directed to hcpf_maternalchildhealth@state.co.us.
Questions about claims and billing must be directed to the fiscal agent, Gainwell Technologies. Visit the Provider Contacts web page for a list of resources.