Lactation Consultations

Doctor listening to patient

Comprehensive Breastfeeding Support, Supplies and Counseling

In accordance with its Medical Policy, CareFirst covers lactation consultations as a preventive service for members who need support with the initiation and continuation of breastfeeding.

Coverage for comprehensive breastfeeding support, supplies and counseling is authorized as a preventive service under provisions of the Patient Protection and Affordable Care Act (ACA). The U.S. Department of Health and Human Services (DHHS) released health plan coverage guidelines through the Heath Resources and Services Administration (HRSA), that require health insurance plans to cover lactation consultations, breast pumps, and certain other women's services as preventive services.

What is a lactation consultation?

Lactation consultation refers to comprehensive breastfeeding education, support, counseling, clinical management and interventions provided to women during the antenatal, perinatal, and postpartum period to support the initiation, maintenance and continuation of breastfeeding, including when provided to women who encounter difficulties breastfeeding due to anatomic variations, complications, and feeding problems with newborns.

Lactation consultations include, but are not limited to:

  • Pre- and post-natal counseling about the initiation of breastfeeding, and that factors that may affect breastfeeding and lactation;
  • Lactation classes;
  • Establishment of a lactation plan;
  • Assessment of breastfeeding performance and evaluation of milk transfer;
  • Counseling and instruction in positioning techniques, latching to the breast, feeding cues, expression of milk, and use of a breast pump or supplementation if indicated; and,
  • Counseling to address breastfeeding related situations such as when the woman has lactation related breast conditions (e.g. engorgement, abscess, cracked nipple or mastitis) inadequate milk transfer or supply, tongue tie, feeding multiple infants, a premature infant, infant in special medical situations, or other maternal factors.

Lactation consultations may occur at a hospital, clinic, breastfeeding center, doctor's office, or the home, or through CareFirst Video Visit where members have access via smartphone, tablet or computer. Lactation Consultants are covered as a no cost preventive service for women.

Who provides lactation consultations?

Lactation consultations may be provided by certain licensed medical professionals who possesses specific training in lactation consultation. Other medical professionals may provide lactation consultations if they have one of the following certifications:

  • CLC - Certified Lactation Counselors (CLC) are professional breastfeeding specialists trained and certified to counsel mothers about breastfeeding and to help with a variety of breastfeeding issues.
  • IBCLC - An International Board-Certified Lactation Consultant (IBCLC) specializes in comprehensive breastfeeding support and counseling, and the clinical management of breastfeeding. An IBCLC has completed extensive formal lactation education, clinical training, has passed an international certification exam, and has continuing education requirements in lactation. They may also be called a Registered Lactation Consultant.

How can I find a network provider and additional information about this benefit?

  • Contact Member Services at the number on the back of your member ID card.
  • To locate providers that participate with CareFirst, use Find a Doctor and search for Lactation, Breastfeeding, Lactation Consultant or Lactation Specialist under the Specialty tab.
  • To locate a provider that is in-network for your specific medical plan, log in to My Account, then use Find a Doctor to search for Lactation, Breastfeeding, Lactation Consultant or Lactation Specialist under the Specialty tab.
  • Members may use CareFirst Video Visit to access board-certified lactation consultants from their smartphone, tablet or computer from the comfort of home.
  • Review CareFirst’s Medical Policy: