Lactation Consultants

Professional lactation services provide counseling or behavioral interventions to improve breastfeeding outcomes.

The primary focus of support is encouragement, education and managing lactation crisis.

Who Qualifies for this Service?

  • Pregnant and/or up to 60 days postpartum SoonerCare members 
  • Soon-to-be-Sooners members while they are still pregnant. Mother’s coverage ends at the time of delivery.

What Services do Lactation Consultants Provide?

  • Individualized prenatal education/training for first time mothers, women who have not previously breastfed or have had problems breastfeeding
  • Help for women who are expecting an infant with a condition that may interfere with breastfeeding
  • Assistance with latch-on difficulties
  • Help to a mother breastfeeding a premature baby
  • Techniques when breastfeeding twins and triplets
  • Education and assistance on re-lactation and adoptive breastfeeding
  • Assistance for special needs baby, e.g. Down Syndrome, cleft lip/or palate

Who Qualifies to Provide Services?

Lactation consultants with a current OHCA provider contract who are Licensed Nurses or Licensed Registered Dietitians and are International Board Certified Lactation Consultants, Registered Lactation Consultants (IBCLC, RLC).

What Procedures are Covered Under Lactation Consultation?

  • S9443—Initial Assessment/Lactation Consultant Services (individual)
  • S9445—Lactation Consultant Services (individual)

What are the Service Limitations and Conditions?

  • 6 sessions per pregnancy/60 days postpartum
  • Self-referred or referred by any provider (no formal referral needed)
  • Services must be provided in office, home or other outpatient clinic setting
  • Services must be medically necessary

What Documentation Must be Maintained by the Lactation Consultant?

Services must be documented in medical record to include:

  • Date of service
  • Start and stop time for each session
  • Service provider signature and credentials
  • Documentation of referral source
  • Treatment plan including problems, goals and/or objectives
  • Methods (to be) used to address problems, goals and objectives
  • Progress made
  • Client response to the session/intervention
  • Any new problems, goals or objectives identified