E0604 Hosp grade elec breast pumpBreast pump, hospital grade, electric (ac and / or dc), any type
2 of 2 payer prior-auth lists that name E0604 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 |
E0604 appears in 3 coverage policies from Aetna, Anthem, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Breast Pumps (0421) | covered if criteria are met | Jun 30, 2026 | payer document |
| Anthem | Electric Breast Pumps (CG-DME-35) | covered if criteria are met | May 14, 2026 | payer document |
| Premera Blue Cross | Preventive Care Procedure Code(s) | Comments | covered if criteria are met | Sep 21, 2026 | payer document |
Prior authorization required or conditional in CO, FL, IN, KY, MA, MD, ND, NY, VA, WA, WY.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.