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As reimbursement for lactation services continues to evolve, more IBCLC practices are asking the same question: "Should we hire a physician so we can bill everything incident to them?" At first glance, it sounds like a smart business strategy. Many practice owners assume they can hire a physician to provide a small amount of oversight—perhaps a few telehealth visits each week—and then bill all lactation services under that physician for higher reimbursement. Unfortunately, in

On its face, New York's proposed Senate Bill S1670 / Assembly Bill A4677 is exciting news for breastfeeding families. The legislation would require many health insurance plans to provide coverage for outpatient lactation services, helping more families access the breastfeeding support they need. As someone who has spent years working in lactation billing and insurance credentialing, I strongly support expanding access to quality lactation care. However, after reviewing the bi

The Affordable Care Act expanded access to breastfeeding support—but it did not eliminate every patient's financial responsibility. One of the biggest misconceptions in lactation billing is the belief that: "Breastfeeding services should always be 100% covered, so patients should never receive a bill." While that would certainly make life easier for both providers and patients, it simply isn't how health insurance works. In fact, failing to collect a patient's required financ

The services you provide—not the patient's remaining benefits—should determine what appears on the claim. One billing practice we've seen recommended is to remove HCPCS code S9443 from an Aetna claim once a patient has exhausted their covered lactation counseling benefit. The reasoning is often that leaving S9443 on the claim may cause the remaining balance to be assigned to the patient. While that may sound like a way to protect the patient, it raises an important compliance

And why TRICARE is the exception—not the rule. One of the most common questions we receive is: "Why don't you bill 99404 for telehealth lactation visits?" The answer is simple: Because billing should follow the payer's published policy—not just what happens to pay. While some billing companies routinely submit 99404 for commercial telehealth lactation visits, we generally do not. The one major exception is TRICARE, which has a unique breastfeeding benefit that specifically re

When "adding a modifier to make it pay" creates more risk than reward. One of the most common coding mistakes I see in lactation billing is the routine use of modifier 59. Some billing companies automatically append modifier 59 whenever a claim denies or when multiple codes are billed together. While that may occasionally result in payment, it is not what modifier 59 was designed for—and using it without a valid reason can significantly increase a provider's audit risk. What

Why getting paid doesn't always mean the claim was billed correctly. As insurance coverage for lactation services continues to evolve, many IBCLCs are looking for ways to obtain reimbursement from commercial insurance plans. Unfortunately, some billing companies and online groups have begun recommending the use of Medical Nutrition Therapy (MNT) codes—particularly 97802 and 97803—for routine lactation consultations. The reasoning is often simple: "The claims pay." However, pa

According to industry reports, billing errors and lack of visibility into claims contribute to billions of dollars in lost or delayed revenue each year. For individual healthcare providers, this lack of transparency can mean more than financial uncertainty—it can impact compliance, patient trust, and professional accountability. As healthcare providers increasingly partner with third-party organizations for billing and insurance administration, one issue deserves far more att

If you've ever billed Aetna for lactation services, you've probably realized that it doesn't work quite like most other commercial insurance plans. Questions such as: Should I bill S9443? Do I also bill a time-based code? Can I use a home visit E/M code? What counts toward Aetna's six covered lactation visits? How should I bill time when both the breastfeeding parent and infant are seen? are among the most common questions we hear from IBCLCs. While every provider must code a

One of the most common questions IBCLCs ask is whether they should bill HCPCS S9443 or CPT 98960 for a lactation consultation. The answer is: it depends on the patient's insurance company. Although both codes are commonly used for lactation services, they were created for different purposes and are interpreted differently by insurance companies. Understanding those differences can help you avoid claim denials, duplicate billing issues, and audit risk. What Is S9443? HCPCS S94

The short answer is yes—but whether you'll be paid depends on the patient's insurance plan, the payer's policies, and how the visit is documented and billed. Telehealth has become an important tool for lactation care, allowing IBCLCs to support families who may otherwise have difficulty accessing services. However, unlike many other healthcare specialties, telehealth coverage for lactation services is far from consistent. Understanding when telehealth is covered—and when it i

One of the most common areas of confusion for new and growing IBCLC practices is the difference between an Individual NPI (Type 1) and a Group NPI (Type 2). Understanding when you need each—and how different insurance companies use them—can save you significant time and frustration during credentialing. What Is an Individual (Type 1) NPI? A Type 1 NPI identifies an individual healthcare provider. Every IBCLC who bills insurance should have their own Type 1 NPI. This number fo

When I first heard about remote billing for healthcare, I was curious but also a bit skeptical. How could something as complex and sensitive as medical billing be handled effectively from a distance? Over time, I’ve come to appreciate the many benefits and practicalities of this approach. If you’re looking to expand your practice’s reach and streamline your billing process, understanding remote medical billing administration is essential. Let me walk you through what I’ve lea

For many healthcare providers, insurance billing follows a relatively predictable process. A patient schedules an appointment, receives treatment, the provider submits a claim using standard diagnosis and procedure codes, and the insurance company determines payment based on the patient’s benefits and network status. Lactation care is different. In fact, lactation billing faces unique challenges that few other specialties encounter, creating confusion for providers, patients,

In today’s competitive market, businesses face increasing pressure to maintain high standards and comply with industry regulations. Credentialing companies offer specialized services that help organizations verify qualifications, licenses, and certifications efficiently. Partnering with these companies can unlock significant benefits, from saving time to reducing risks. This post explores the key advantages of working with credentialing companies and how they can support your