Lactation Billing:
UHC Confirms Policy
Schedule: July 2026 Reimbursement Update
July 2026 Update: UnitedHealthcare Confirms September 1, 2026 Policy Will Move Forward
Last Updated: July 7, 2026
UnitedHealthcare has confirmed that its reimbursement policy affecting HCPCS S9443 will proceed as scheduled on September 1, 2026. In its response, UnitedHealthcare states that the policy does not violate the Affordable Care Act and explains that the change is intended to 'align with CMS' by reimbursing HCPCS S9443 only when billed under the mother's claim. Claims submitted for S9443 under an infant's claim will no longer be reimbursed. UnitedHealthcare also describes breastfeeding as a 'mother-infant dyad' and states that a single maternal reimbursement appropriately reflects the integrated nature of lactation counseling.
Why Many Providers Remain Concerned
While UnitedHealthcare has explained the reasoning behind its policy, many lactation providers believe the practical impact extends beyond a simple billing change. A comprehensive IBCLC visit commonly includes assessment of both the breastfeeding parent and the infant, including feeding effectiveness, milk transfer, oral function, weight concerns, maternal breastfeeding issues, documentation, care planning, and coordination with other healthcare providers. These visits frequently last 60 to 180 minutes and may occur in the home or office.
For many independently practicing IBCLCs, HCPCS S9443 and CPT 98960 are the primary commercially reimbursable codes available for comprehensive lactation services. Due to coding rules, payer policies, and duplicate billing concerns, CPT 98960 is not always an appropriate substitute for the reimbursement eliminated under this policy. As a result, many providers anticipate that reimbursement for the same clinical work may be reduced significantly despite no reduction in the time, complexity, or professional responsibility associated with the visit.
Questions Raised by the Policy
Providers have also questioned UnitedHealthcare's characterization that this policy 'aligns with CMS.' CMS administers the Medicare program and maintains the HCPCS code set and related claims-processing edits. However, Medicare generally does not reimburse HCPCS S9443 as a covered Medicare benefit. UnitedHealthcare has independently elected to reimburse S9443 within its commercial preventive benefits and has now chosen to adopt a Medicare administrative age edit as part of its commercial reimbursement policy. This has led some providers to question whether the policy represents a required alignment with CMS or an independent commercial reimbursement decision.
Potential Impact on Patient Access
Practices across the country are evaluating how this policy may affect their ability to continue providing comprehensive lactation care to UnitedHealthcare members. Areas of concern include:
• Reduced reimbursement for extended lactation consultations.
• Financial sustainability of home-visit services.
• Access to care in rural and underserved communities.
• Continued network participation by independent lactation providers.
• Availability of comprehensive evaluations involving both the breastfeeding parent and infant.
To better understand these potential effects, we are collecting information from lactation practices nationwide regarding anticipated changes to provider participation, appointment availability, and reimbursement. Aggregate findings may be shared with state and federal regulators upon request to assist in evaluating the policy's impact on patient access.
This page will continue to be updated as additional information becomes available.
Provider Impact Survey
If your practice contracts with UnitedHealthcare and provides lactation services, we invite you to complete our brief survey.
The survey collects practice-level information only, including:
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Average visit length
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Typical reimbursement before and after the policy change
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Home versus office visits
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Anticipated impact on your practice
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Whether you expect to reduce services or reconsider network participation
No patient information or protected health information (PHI) should be submitted.
Complete the survey here:
Why We're Collecting This Information
The purpose of this project is to document how this reimbursement change may affect:
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Patient access to comprehensive lactation care
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Independent provider participation
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Home-based lactation services
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Rural and underserved communities
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Availability of extended and medically complex lactation visits
Survey responses will be compiled in aggregate to help illustrate the practical effects of the policy. Individual practice information will not be published without permission.
Regulatory Outreach
We are preparing informational submissions to appropriate regulatory agencies to request review of the potential impact of this policy. Depending on the type of health plan and regulatory authority involved, outreach may include:
Federal Agencies
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U.S. Department of Health and Human Services (HHS)
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Centers for Medicare & Medicaid Services (CMS)
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U.S. Department of Labor – Employee Benefits Security Administration (EBSA)
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Health Resources and Services Administration (HRSA)
State Agencies
For fully insured commercial UnitedHealthcare plans, information may also be submitted to the applicable State Department of Insurance or Insurance Commissioner in states where affected providers and patients are located.
Supporting Documentation
We are also compiling supporting materials that may be provided to regulators upon request, including:
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Clinical descriptions of comprehensive lactation visits
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Reimbursement analyses
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Aggregate provider survey results
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Practice impact statements
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Relevant policy documents and supporting references
Will the Billing Group provide further updates?
UHC Lactation Policy FAQ
LAST UPDATED: July 7, 2026
When do these proposed changes take effect?
The proposed UnitedHealthcare (UHC) policy changes are currently scheduled to be finalized and take effect on September 1, 2026.
Is S9443 currently covered by UHC?
Yes, HCPCS code S9443 is widely recognized for lactation support services. However, the new UHC proposal seeks to restrict coverage for this code strictly to beneficiaries aged 9–64, which departs from current industry standards and the code's own descriptor.
How do these changes affect IBCLCs?
These age-based constraints would drastically limit reimbursement, as S9443 is often the only billable code available to IBCLCs under UHC. Because infants remain covered insurance beneficiaries, in-network providers cannot bill families directly for denied services. Consequently, these changes would effectively mandate that providers treat infants for free, threatening the financial viability of lactation practices and creating significant barriers to essential care for newborns and families.
How can I join the objection process?
If you are an IBCLC, physician, nurse practitioner, physician assistant, certified nurse-midwife, or other clinician providing lactation services under a UnitedHealthcare contract, your participation is valuable.
Every response helps provide a more accurate picture of how this policy may affect providers and the families they serve.
If you have questions or would like to contribute additional information, please contact us through our website.
Absolutely. Sunshyn will share critical updates as UHC’s review progresses. We are dedicated to advocating for fair reimbursement and keeping you informed of any procedural changes.