United Healthcare updates lactation reimbursement policy

Families covered by United Healthcare could see changes to how some breastfeeding support services are reimbursed beginning Sept. 1, as the insurer limits payment for lactation counseling visits to the mother.

The policy applies to HCPCS code S9443, a billing code used for lactation counseling. In practice, the change affects how some providers are reimbursed when a breastfeeding consultation involves assessments of both the mother and infant during the same visit. United Healthcare said it will no longer reimburse claims submitted under an infant's medical record using that code and will instead reimburse one counseling visit per date of service.

The policy does not eliminate lactation counseling coverage, but it changes how some breastfeeding consultations are reimbursed.

For Mississippi families seeking breastfeeding support, the change has raised questions about how lactation services will be reimbursed and whether providers may need to adjust how they deliver or bill for care.

United Healthcare is one of Mississippi's largest health insurers, accounting for about 10% of the state's accident and health insurance market based on premiums written in 2024, according to a Mississippi Insurance Department market share report.

United Healthcare said lactation counseling remains a covered benefit.

"Lactation counseling is an important service that mothers rely on during their breastfeeding journey, and we continue to cover it," a United Healthcare spokesperson said in a written statement.

United Healthcare said some providers bill separately for the mother and infant during the same consultation and that the insurer considers those claims to be duplicate payments. The company said the policy is intended to align reimbursement practices with guidance from the Centers for Medicare & Medicaid Services and the American Academy of Pediatrics.

A poster at Memorial Health displays the World Health Organization and UNICEF's "Ten Steps to Successful Breastfeeding," a set of recommended practices for supporting breastfeeding families. (RHCJC News)

When asked to provide the specific guidance it cited, United Healthcare referred RHCJC News to a CMS document describing age parameters for code S9443 and an American Academy of Pediatrics resource discussing the mother-infant breastfeeding relationship.

RHCJC News contacted CMS and the AAP seeking clarification. Neither identified a specific policy stating lactation counseling must be organized only under the mother, despite United Healthcare citing both organizations when explaining the change. Both referred questions about the insurer's reimbursement practices back to United Healthcare.

RHCJC News also asked United Healthcare how providers should bill infant-specific feeding concerns, such as poor weight gain, tongue-tie and other feeding-related issues identified during a lactation consultation. The company did not respond before publication.

Providers interviewed for this story said they often assess both the mother and infant because feeding problems can originate with either patient.

Maranda Nybo, an International Board Certified Lactation Consultant and owner of Gulf Coast Breastfeeding Center in Pass Christian, said initial consultations typically include separate assessments of both patients.

"It is frustrating as a lactation consultant to be basically told that that is not acceptable when I'm clearly having two patients," Nybo said. "I'm touching two separate people."

A baby scale sits on a changing table alongside diapers and other supplies inside the Breastfeeding Center at Memorial Health. The center provides breastfeeding and lactation support to families. (RHCJC News)

Marissa Black, a registered nurse and certified lactation counselor at Memorial Health, said lactation consultations often involve different medical considerations for both mother and baby.

She said maternal factors such as blood loss, hormone disorders or prior breast surgery can affect milk production, while infants may experience tongue-ties, birth-related complications or latch difficulties that require separate evaluation.

Nybo said the policy could reduce reimbursement for providers who assess both mothers and infants during the same visit, although its impact on individual practices remains unclear.

"That is undermining and undercutting us as lactation consultants," Nybo said. "That just makes it harder for us."

Black said families already face barriers to breastfeeding support, including transportation challenges and difficulties obtaining breast pumps.

"If we don't have the resources out there to help these moms, they give up easier because it's easier to feed your baby a bottle," Black said. "We need those resources out there to help them along the way."

Leslie Rollins, a Hattiesburg nurse practitioner, International Board Certified Lactation Consultant and mother of two, said individualized support remains important because every mother and infant faces different circumstances and challenges.

"Breastfeeding isn't one size fits all," Rollins said.