Changes to Breast Pump Supplies, Temporomandibular Joint (TMJ) Splints, and Compression Garment Limits

Effective July 1, 2021, there will be limit reductions for breast pump supplies, Temporomandibular Joint (TMJ) splints and gradient compression garments. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has updated its Supply and Equipment Reimbursement policy to reflect these changes.

Supply and Equipment Limit Updates

• Breast pump supplies (A4281-A4286) will be limited to two units per code, per year.

• Occlusal orthotic devices (D7880) for TMJ will be limited to one per year.

  • Device adjustments (D7881) performed in the first year will be included in the reimbursement of the device.
  • After the first year, adjustments will be reimbursable once every 3 months.

• Gradient compression garments for the upper and lower extremity (A6530 – A6549) will be limited to eight individual units per year (or four pairs).

  • The previous yearly limit for compression garments was 12 units (six pairs).

These changes apply to the following lines of business: Administrative Services Only (ASO groups), fully insured membership, Blue Card IPP Host, and the State Health Plan (SHP).

This update is for informational purposes only. No further action is required.