Clinical UM Guideline

This document addresses the use of standard electric breast pumps (non-hospital grade) or heavy-duty, hospital-grade breast pumps for initiating and maintaining expression of human breast milk in specified situations.

Note: For a high-level overview of this document, please see “Summary for Members and Families” below. 

Medically Necessary:

A standard, non-hospital grade, electric breast pump is considered medically necessary when there is documentation of ongoing breastfeeding.

An electric, heavy-duty, hospital-grade breast pump is considered medically necessary for any of the following indications:

1. When a breastfeeding infant is confined to the hospital; or
2. When a breastfeeding infant has a medical (for example, respiratory, cardiac or genetic condition) or congenital condition (for example, cleft palate) that interferes with breastfeeding; or
3. When the lactating individual has been unsuccessful expressing sufficient breast milk after a trial using a manual, battery powered or standard electric pump.

Not Medically Necessary:

An electric breast pump (standard non-hospital grade or heavy-duty hospital grade) is considered not medically necessary in the absence of ongoing breastfeeding.

An electric, heavy-duty, hospital grade breast pump is considered not medically necessary when the criteria above are not met.

This document describes clinical studies and expert recommendations, and explains when use of an electric breast pump is medically appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information:

Breast pumps are devices that help a lactating parent remove milk from the breast. There are standard electric pumps for personal use and heavy duty electric pumps, sometimes called hospital grade pumps, that are stronger and made for frequent use. Standard electric pumps may help parents continue breastfeeding when direct feeding is not possible. Heavy duty pumps may be needed when a baby is in the hospital, has certain medical conditions that make feeding at the breast hard, or when a parent cannot make enough milk using other types of pumps. These pumps can support milk supply, but they may cause breast soreness or discomfort if not used correctly.

What the Studies Show:

Breastfeeding has many health benefits for babies and lactating parents. Babies who receive human milk have a lower risk of diarrhea, ear infections, and lung infections in the first year of life. Health groups such as the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the World Health Organization (WHO) recommend exclusive breastfeeding for about 6 months, followed by continued breastfeeding with solid foods.

Research shows that different ways of expressing milk, such as hand expression, manual pumps, and electric pumps, can all work. A review of many studies found that hand expression worked as well as electric pumps for some outcomes, including infant growth. The best method may depend on the parent’s situation and the baby’s health. Heavy duty electric pumps are often used when a baby is premature, sick, or in a neonatal intensive care unit. These pumps are stronger and meant for frequent use. However, they are larger and less portable. Using a pump may cause nipple pain, breast swelling, or plugged ducts if not used properly. Parents should receive instruction on correct use to lower these risks. Better studies are needed to know if one type of pump is better than another for improving long term health.

When is an Electric Breast Pump Clinically Appropriate?

Electric breast pumps may be appropriate in these situations:

• A standard, non-hospital grade electric breast pump may be appropriate when there is documentation of ongoing breastfeeding.
• A heavy duty, hospital grade electric breast pump may be appropriate when any of the following apply:
  • The breastfeeding infant is confined to the hospital; or
  • The breastfeeding infant has a medical condition, such as breathing, heart, genetic, or other health problems, or a congenital condition such as cleft palate, that interferes with breastfeeding; or
  • The lactating parent has not been able to express enough milk after trying a manual, battery powered, or standard electric pump.

When is this not Clinically Appropriate?

• An electric breast pump, whether standard or heavy duty, is not clinically appropriate when there is no ongoing breastfeeding.
• A heavy duty, hospital grade electric breast pump is not clinically appropriate when the conditions listed above are not present.
• Using equipment that is not medically needed may lead to discomfort or inconvenience without clear health benefit.
• Electric breast pumps are not clinically appropriate in scenarios other than those listed above.

(Return to Description)

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary.

Summary:

Breast pumps are FDA-regulated medical devices used to express breast milk for maintaining supply, relieving discomfort, and supporting infant nutrition, with types including manual, electric, and heavy-duty multi-user pumps typically used in hospital settings. These devices play a critical role when direct breastfeeding is not possible, particularly for infants with medical needs, and are supported by clinical guidelines recommending early and frequent milk expression to establish supply. Major health organizations, including the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the World Health Organization (WHO), and others, strongly endorse breastfeeding due to its significant health benefits for both infants and lactating individuals, recommending exclusive breastfeeding for about six months and continued breastfeeding up to two years or longer. Despite high initiation rates, sustained exclusive breastfeeding remains low in the U.S., highlighting the importance of interventions such as lactation support, access to breast pumps, and workplace accommodations. Evidence shows that multiple methods of milk expression can be effective, and access to appropriate equipment improves breastfeeding outcomes. Policies under the Affordable Care Act require insurance coverage for breastfeeding support and equipment, while ongoing advancements in pump technology and updated clinical guidelines continue to promote breastfeeding accessibility, inclusivity, and effectiveness across diverse populations and clinical situations.

Discussion

The Food and Drug Administration (FDA) regulates breast pumps as medical devices that extract or express breast milk. Breast pumps may be used to increase or maintain an individual’s milk supply, relieve engorged breasts and plugged milk ducts, or pull out flat or inverted nipples so a nursing baby can more easily latch-on to the breast (FDA, 2018). There are three main types of breast pumps: manual, battery-powered and electric pumps. Standard manual and electric breast pumps are intended for single person use and are typically sold as a medical device. The standard models may be available from lactation and durable medical equipment (DME) providers as well as select retail stores. Expression of human milk from the breast with standard powered (electric) or non-powered (manual) breast pumps may facilitate ongoing nutritional requirements of infants.

An electric, heavy-duty breast pump is a pump approved by the FDA for safe use by multiple users, where each individual uses their own collection kit (typically includes breast shields and tubing). These pumps are more durable and powerful to support more frequent pumping of breast milk. Heavy-duty pumps are larger, heavier, and not as portable as the typical personal electric breast pump. These devices are available in the hospital setting for lactating individuals who have hospitalized infants. Lactation consultants, specialty medical supply stores, and DME supply sources may rent or sell hospital-grade breast pumps. The FDA (2018) website states “Please note that the term “hospital-grade pump” is not recognized by the FDA and there is no consistent definition for this term, so individual companies could mean different things when they label their breast pumps as hospital-grade.”

An electric, heavy-duty, hospital-grade breast pump is recommended for lactating individuals who are dependent on the expression of pumped breast milk (initiation or continuation of milk production) due to circumstances that do not allow for breastfeeding. Expressed breast milk is needed when the infant is unable to breastfeed due to medical (for example, confinement in an intensive care unit, prematurity, apnea, etc.) and/or congenital reasons (for example, a cleft lip). During these situations, the lactating individual needs to extract breast milk in order to provide nutrients necessary for healthy growth and development.

The National Association of Neonatal Nurses (NANN, 2016) issued a position statement on the use of human milk and breastfeeding in the neonatal intensive care unit (NICU). Recommendations include use of a hospital-grade electric pump with a double collection kit to initiate lactation and establish an adequate milk supply. NANN states it is critical to monitor breast milk supply from pumping early and frequently during the first 2 weeks to ensure that the lactating individual will have an adequate supply at the time of the infant‘s discharge.

Breastfeeding and human milk provide natural, normal nutrition for all infants. There are many short- and long-term benefits of breastfeeding for both infant and the lactating individual. Exclusive breastfeeding is recommended for the first 6 months of life by the ACOG (2016), AAP (2012), and the WHO(2018). The AAP recommends breast feeding continue through the infant’s first year of life or longer.

Various groups continue to support promotion of breastfeeding interventions to improve the rate of breastfeeding in the United States. The U.S. Preventive Services Task Force (USPSTF, 2016, 2025) recommends interventions during pregnancy and after birth to promote and support the initiation and continuation of breastfeeding.

Benefits of breastfeeding include a lower risk of diarrhea, otitis media and lower respiratory tract diseases than bottle-fed infants during the first year of life (AAP, 2012).

While the benefits of breastfeeding are well documented and the majority of individuals in the United States initiate breastfeeding, the incidence of continued breastfeeding drops sharply by 3 months. According to a 2016 survey, 81.1% of individuals initiate breastfeeding following birth. At 6 months of age only 22.3% of infants have been exclusively fed breastmilk (Meeks, 2017). While individuals initially report intention to breastfeed exclusively for at least 3 months, only 32.4% report achieving this goal (Meeks, 2017).

An update of a 2008 Cochrane study analyzed the methods of breast milk expression for lactating individuals, data from 1998 individuals in 34 studies (Becker, 2014). The studies were conducted in the U.S. and at international sites which included preterm or ill neonates as well as term and older healthy infants. Milk expression was achieved by a variety of methods which included hand-expression, manual pumps and electric pumps. The authors concluded that the time of birth and the purpose for expression of breast milk influence the most suitable method for expressing milk. Methods to promote optimal milk expression (such as early initiation of milk expression, relaxation music, hand expression, manual pumps and warming of the breasts) were “As effective or more effective, than large electric pumps for some outcomes.” The authors noted caution in interpretation of the results as the interventions and study methodologies varied across the studies.

In 2011, the Institute of Medicine (IOM), now the National Academy of Medicine, Committee on Preventive Services for Women issued recommendations identifying preventive services necessary to improve women’s health and well-being. As part of these recommendations, the Committee included comprehensive lactation support and counseling, as well as costs for renting breastfeeding equipment, as preventive services. The IOM concluded that breastfeeding support and access to breast pumps are evidence-based interventions that improve breastfeeding initiation, duration, and exclusivity, and thereby contribute to improved maternal and infant health outcomes. The Committee recognized that barriers such as lack of workplace accommodations, limited access to lactation counseling, and lack of appropriate equipment may impede breastfeeding continuation. Access to breast pumps was identified as an important component of facilitating successful breastfeeding, particularly when direct breastfeeding is not possible.

In response to the Patient Protection and Affordable Care Act, the U.S. Department of Health and Human Services (DHHS) released health plan coverage guidelines partially based on recommendations from the IOM that require health insurance plans cover breast pumps and certain other preventive services. Beginning on or after August 1, 2012, new health plans and non-grandfathered plans are required to provide coverage consistent with these guidelines in the first plan year (in the individual market, policy year), when delivered by a network provider. The guidelines recommend coverage of costs for renting breast feeding equipment for each birth.

In 2020 the Academy of Breastfeeding Medicine (ABM) published a clinical protocol: “Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients” which states:

Standard guidance on exclusive breastfeeding may need to be altered based on the expected production of a non-gestational parent and whether milk will be provided by a gestational parent. For instance, full production is not usually achievable in induced lactation, or after ‘‘top’’ surgery. Therefore, parents should be encouraged to provide as much human milk as possible, and be educated on the indications for supplementation, types and methods of supplementation, and need for close follow-up.

In 2022 the ABM revised their guidelines to include the following recommendations; when the lactating individual is medically ready for hospital discharge, but the newborn is not, or vice versa, the newborn and lactating individual should continue 24-hour rooming in to facilitate breastfeeding. The lactating individual should be encouraged to spend as much time as possible with the hospitalized newborn, regularly breastfeed, and be instructed in techniques to express breast milk so that expressed milk can be given to the hospitalized newborn if separation occurs. It should also be ensured the lactating individual has access to a breast pump or knows how to hand express if a breast pump is not available. High-quality education regarding breast pump use should be provided. Programs should be in place for the lactating individual to borrow a pump for use at home if the individual does not otherwise have access.

The AAP (2022) policy on breastfeeding and the use of human milk supports policies that protect breastfeeding including universal paid maternity leave, the right of an individual to breastfeed in public, insurance coverage for lactation support and breast pumps, universal workplace break time with a clean, private location for expressing milk, the right to feed expressed milk, and the right to breastfeed in childcare centers and lactation rooms in schools to sustain breastfeeding.

In 2023, ACOG published an update to the previous 2016 breastfeeding recommendation. The updated guidance supports continued breastfeeding while foods are introduced, if mutually desired by a lactating parent and child, for up to 2 years or beyond. The new recommendation is based on alignment with the AAP’s 2022 updated guidance that documented the benefits of breastfeeding for both the lactating parent and the child. These recommendations are also aligned with the 2023 World Health Organization (WHO) guidelines that recommend initiating breastfeeding within the first hour of a child's birth and exclusively breastfeeding for the first six months. During this period, no other food or liquid, including water, should be given to the infant. Infants should be breastfed as often as they demand, at any time of the day or night. Introduction of nutritionally-adequate and safe solid foods at 6 months, together with continued breastfeeding up to 2 years of age is desired when possible.

The ABM recommends exclusive breastfeeding as the optimal method of feeding for the first 6 months after birth, and with complementary foods for 2 years or as long as the family desires. The ABM also recommends assessment and prevention of underfeeding and overfeeding infant in the context of skilled breastfeeding management (ABM, 2024).

Additionally, ABM published a clinical protocol “Model Maternity Policy Supportive of Breastfeeding” in 2025 that states:

Maternity facilities must have a policy that protects and supports breastfeeding. It should include all the Ten Steps, which must be implemented as a whole package. External assessments are recommended to ensure compliance with requirements. Continuous monitoring of practices should be routine. Ensuring that health workers who deal directly with mothers and infants have the competencies needed to protect and support breastfeeding through counseling and person-centered care is strongly recommended.

The ABM Ten Steps of Breastfeeding refers to the Academie’s interpretation and clinical support of the WHO/United Nations International Children's Emergency Fund (UNICEF) Ten Steps to Successful Breastfeeding, which form the foundation of the Baby-Friendly Hospital Initiative. These steps are evidence-based practices that maternity facilities should implement to support breastfeeding initiation and continuation. Step # 8 includes Medically Indicated Supplementation which provides clear clinical indications for supplementation, guidance on preferred supplementation hierarchy (mother’s milk → donor milk → formula when indicated), and emphasis on protecting milk supply when supplementation is necessary.

In 2025 the American Academy of Family Physicians (AAFP) reaffirmed the USPSTF clinical preventive service recommendation on breastfeeding which provide a Grade B recommendation for all pregnant and postpartum women. The recommendation applies to all adolescents and adults who are pregnant, and their infants and children. It also notes that interventions may involve partners, other family members, and friends. The recommendation does not apply in circumstances where there are contraindications to breastfeeding (such as certain maternal medical conditions or infant metabolic disorders).

Additionally, the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer (V.1.2026) states:

Breastfeeding after breast-conservation therapy is not contraindicated. However, the quantity and quality of breast milk produced by the conserved breast may not be sufficient or may be lacking some of the nutrients needed.

Breastfeeding is not recommended during active treatment with chemotherapy and endocrine therapy or within 6 months of completing pertuzumab or trastuzumab. Breastfeeding during endocrine or chemotherapy treatment is not recommended by the NCCN Panel because of risks to the infant.

Breastfeeding after breast-conserving treatment for breast cancer is not contraindicated. However, lactation from an irradiated breast may not be possible, or may occur only with a diminished capacity.

A review of 45 studies evaluated the effects of different methods of expressing and processing mother’s own milk on infant health and growth outcomes. Three studies found that provision of hindmilk was associated with improved infant weight gain, with moderate certainty of evidence supporting this finding. Hand expression demonstrated similar efficacy to electric pumping with respect to infant growth outcomes, including among preterm infants. Evidence regarding the impact of milk processing methods on morbidity and mortality was inconclusive. Pasteurization was more effective than freeze-thaw cycling in reducing cytomegalovirus transmission; however, evidence supporting freeze-thaw alone was limited. No studies assessed clinical outcomes related to hygiene practices or the setting of milk expression. The authors concluded that the evidence on the clinical effects of different milk expression practices and treatments remains limited (Gandino, 2025).

In recent years, there have been several advances in breastfeeding equipment which could encourage breastfeeding for a longer period of time. Devices are available which are worn inside the bra and allow an individual to perform activities of daily living while pumping. Other devices support wireless connectivity and allow for tracking of pumping and infant activities. Standard non-hospital grade breast pumps can include these features and can be considered appropriate as a means of promoting infant health.

Electric breast pump: A powered breast pump, electrically powered suction device used to express milk from the breast.

Hospital-grade breast pump: Non-standard, electric, heavy-duty breast pump, which is FDA approved for reuse by multiple lactating individuals (not for single person/personal use).

Manual breast pump: Nonpowered device designed to express breast milk using suction created through a manual process.

Ten Steps to Successful Breastfeeding: The WHO/UNICEF evidence-based practices that maternity facilities should implement to support breastfeeding initiation and continuation.

The Ten Steps consist of:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help women initiate breastfeeding within 1 hour of birth.
5. Show women how to breastfeed and how to maintain lactation, even if they are separated from their newborns.
6. Give newborns no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in—allow mothers and newborns to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer to them on discharge from the hospital or birth center.

Peer Reviewed Publications:

1. Larkin T, Kiehn T, Murphy PK, Uhryniak J. Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers. Adv Neonatal Care. 2013; 13(1):75-82.
2. Martino K, Wagner M, Froh EB, et al. Postdischarge breastfeeding outcomes of infants with complex anomalies that require surgery. J Obstet Gynecol Neonatal Nurs. 2015; 44(3):450-457.
3. Meier PP, Engstrom JL, Hurst NM, et al. A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Breastfeed Med. 2008; 3(3):141-150.
4. Rollins NC, Bhandari N, Hajeebhoy N, et al.; Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016; 387(10017):491-504.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Breastfeeding (ABM). ABM Position Statement. Recommendation for exclusive breastfeeding: Avoidance of underfeeding and overfeeding. October, 2024. Available at: https://www.bfmed.org/assets/DOCUMENTS/PositionStatements/SupplmentationStatement.pdf. Accessed on February 13, 2026.
2. American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice. Obstet Gynecol. 2016; 127(2):e86-e92.
3. American College of Obstetricians and Gynecologists (ACOG). Practice Advisory to Update the Duration of Breastfeeding. February 2023. Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2023/02/duration-of-breastfeeding-update. Accessed on February 13, 2026.
4. Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2015; (2):CD006170.
5. Chantry CJ, Eglash A, Labbok M. ABM Position on Breastfeeding-Revised 2015. Breastfeed Med. 2015; 10(9):407-411.
6. Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008; 149(8):565-582.
7. Committee on Preventive Services for Women; Institute of Medicine. Clinical Preventive Services for Women: Closing the Gaps. July 19, 2011. Available at: https://cdn.cnsnews.com/documents/INSTITUTE%20OF%20MEDICINE-PREVENTIVE%20SERVICES%20REPORT.pdf. Accessed on February 13, 2026.
8. Ferri RL, Rosen-Carole CB, Jackson J, et al. Academy of Breastfeeding Medicine. ABM Clinical Protocol #33: lactation care for lesbian, gay, bisexual, transgender, queer, questioning, plus patients. Breastfeed Med. 2020;15(5):284-293. Available at: https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/Protocol%20%2333%20-%20English%20Translation.pdf. Accessed on February 13, 2026.
9. Gandino S, Cassidy T, Giribaldi M, et al. A systematic review on the influence of feeding expressed mother's own milk using varying expression practices or treatments on health and growth of recipient infants. Adv Nutr. 2025; 16(11):100523.
10. Hoyt-Austin A, Kair L, Larson, I, et al. Guidelines for birth hospitalization discharge of breastfeeding dyads, Revised 2022. Academy of Breastfeeding Medicine Clinical Protocol No. 2. Breastfeeding Medicine, 2022; (17). Available at: https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/ABM%20Protocol%20%232bfm.2022.29203.aeh.pdf. Accessed on February 13, 2026.
11. James DC, Lessen R. American Dietetic Association. Position of the American Dietetic Association: promoting and supporting breastfeeding. J Am Diet Assoc. 2009; 109(11):1926-1942.
12. Johnston M, Landers S, Noble L, et al. Breastfeeding and the use of human milk. Pediatrics. 2012; 129(3):e827-e841.
13. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012; (15):CD003517.
14. Meek JY, Hatcher AJ; Section on Breastfeeding. The breastfeeding-friendly pediatric office practice. Pediatrics. 2017; 139(5):e1-e9.
15. Meek JY, Nobel L. Breastfeeding and the use of human milk. American Academy of Pediatrics, policy statement. Pediatrics. 2022; 150(1):e2022057988.
16. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology^®. © 2026 National Comprehensive Cancer Network, Inc. For additional information visit the NCCN website: http://www.nccn.org/index.asp. Accessed on February 13, 2026.
    • Breast Cancer (V.1.2026). Revised January 16, 2026.
17. Spatz DL, Edwards TM. The use of human milk and breastfeeding in the neonatal intensive care unit: position statement 3065. Adv Neonatal Care. 2016; 16(4):254.
18. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Primary care interventions to support breastfeeding: US Preventive Services Task Force Recommendation Statement. JAMA. 2016; 316(16):1688-1693. Reaffirmed April 11, 2025.
19. World Health Organization. Long-term effects of breastfeeding: a systematic review. 2013. Available at: https://apps.who.int/iris/bitstream/handle/10665/79198/9789241505307_eng.pdf?sequence=1. Accessed on February 13, 2026.

1. American Academy of Family Physicians (AAFP). Clinical preventative service recommendation. Breastfeeding. Available at: https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/breastfeeding.html. Accessed on February 13, 2026.
2. Centers for Disease Control and Prevention. Strategies to prevent obesity and other chronic diseases: the CDC guide to strategies to support breastfeeding mothers and babies. Atlanta: U.S. Department of Health and Human Services; 2013. Available at: http://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF. Accessed on February 13, 2026.
3. Institute of Medicine of the National Academies of Medicine. Clinical Preventative Services for Women: Closing the Gaps (2011). Findings and Recommendations for Addressing Identified Gaps in Preventive Services for Women. Available at: https://nationalacademies.org/read/13181/chapter/9. Accessed on February 27, 2026.
4. United Nations International Children's Emergency Fund (UNICEF). Baby friendly hospital initiative. Ten steps to successful breastfeeding, from UNICEF and the World Health Organization. Available at: https://www.unicef.org/documents/baby-friendly-hospital-initiative. Accessed on February 13, 2026.
5. U.S. Department of Health and Human Services National Institutes of Child Health and Human Development. How do I pump and store breast milk. Last reviewed Jan 31, 2017. Available at: https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/pump. Accessed on February 13, 2026.
6. U.S. Department of Health and Human Services Offices on Women’s Health. Breastfeeding. Last updated February 18, 2021. Available at: https://www.womenshealth.gov/Breastfeeding. Accessed on February 13, 2026.
7. U.S. Food & Drug Administration. Breast Pumps. March 26, 2018. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/BreastPumps/default.htm. Accessed on February 13, 2026.
8. U.S. National Library of Medicine. MedlinePlus. Breastfeeding. Last updated September 25, 2017. Available at: https://www.nlm.nih.gov/medlineplus/breastfeeding.html. Accessed on February 13, 2026.
9. U.S. Preventative Services Task Force. Final Recommendation Statement. Breastfeeding: Primary care behavioral counseling interventions. April 11, 2025. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breastfeeding-primary-care-interventions.  Accessed on February 13, 2026.
10. World Health Organization. Breastfeeding. Updated February 2025. Available at: https://www.who.int/health-topics/breastfeeding#tab=tab_1 Accessed on February 13, 2026.
11. World Health Organization. Infant and young child feeding. December 20, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed on February 27, 2025.
12. World Health Organization. Ten Steps to successful breastfeeding. August 5, 2020. Available at: https://www.who.int/teams/nutrition-and-food-safety/food-and-nutrition-actions-in-health-systems/ten-steps-to-successful-breastfeeding. Accessed on February 13, 2026.

Ameda Elite Breast Pump^®
Ameda Finesse Double Breast Pump^®
Ameda Platinum Breast Pump^®
Ameda Purely Yours Breast Pump^®
Annabella Double Breast Pump
AOJ Health Technology Electric Breast Pumps
AOV Maternity and Baby Electric Breast Pumps
Elvie Stride 2Hygeia Enjoye
Hygeia EnRiche
Hygeia Express Powered Breast Pump
Hygeia QLansinoh SignaturePro
Lansinoh Smartpump
Medela^® Powered Breast Pump Symphony^®
Medela^® Duo Hands-Free Breast Bump
MilkMate Breast Pump
Momcozy Wearable Breast Pumps
Motif DUONurture III Breast Pump^®
NUK Expressive Single Electric Breast PumpSpectra Dew 350 Electric Breast Pump^®
Spectra S1 PLUS Electric Breast Pump^®
Spectra S2 PLUS Electric Breast Pump^®
Tomy Quiet Expressions
VIVACEWearable Breast Pump (S18)
Wearable Breast Pump (Model S32)
White River Automatic Breast Pump^®

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. We reserve the right to review and update Clinical UM Guidelines periodically. Clinical guidelines approved by the Medical Policy & Technology Assessment Committee are available for general adoption by plans or lines of business for consistent review of the medical necessity of services related to the clinical guideline when the plan performs utilization review for the subject. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card.

Alternatively, commercial or FEP plans or lines of business which determine there is not a need to adopt the guideline to review services generally across all providers delivering services to Plan’s or line of business’s members may instead use the clinical guideline for provider education and/or to review the medical necessity of services for any provider who has been notified that his/her/its claims will be reviewed for medical necessity due to billing practices or claims that are not consistent with other providers, in terms of frequency or in some other manner.

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