Prescription Information

Breast Pump

  • A description or HCPC code of the product prescribed (i.e., "double electric breast pump" or E0603).
  • A diagnosis code (DX). Typical diagnosis codes are Z39.1 (Encounter for care and examination of lactating mother) and Z34.83 ( Encounter for supervision of other normal pregnancy, third trimester) there maybe others.
  • Your physician's signature.
  • The date your physician signed the prescription.

Postpartum

  • A description or HCPC code of the product prescribed (i.e., "postpartum recovery garment" or L2640).
  • A quantity up two garments as decided between you and your physician (or midwife).
  • A diagnosis code (DX). Typical diagnosis codes are Z39.2 (Postpartum Follow-up) and M54.5 (Low Back Pain) there maybe others.
  • Your physician's signature.
  • The date your physician signed the prescription.

Compression

  • A description or HCPC code of the product prescribed (i.e., "compression stockings, 20-30 mmHg" or A6530).
  • A quantity up to four pairs as decided between you and your physician (or midwife).
  • A diagnosis code (DX). Typical diagnosis codes are O12.03 (Gestational Edema) and O22.03 (Varicose veins) there may be others.
  • Your physician's signature.
  • The date your physician signed the prescription.

Support Band

  • A description or HCPC code of the product prescribed (i.e., "pregnancy support band" or L0621).
  • A quantity up two garments as decided between you and your physician (or midwife).
  • A diagnosis code (DX). Typical diagnosis codes are M54.5 (Low back pain ) and R10.2 (Pelvic and perineal pain ) there maybe others.
  • Your physician's signature.
  • The date your physician signed the prescription.