We Make Ordering A Breast Pump Easy - MPCS

Breast Pumps
McKesson Patient
Care Solutions
We Make Ordering
A Breast Pump Easy
McKesson Patient Care Solutions Inc. (MPCS) is a
leading provider of breast pumps and accessories.
With fast, efficient and exceptional service, patients
and healthcare professionals have peace of mind
knowing they truly have an ally that focuses on
their needs.
MPCS Product Specialists are Able to:
•Advise which breast pump your insurance plan
will pay for and answer questions about your
coverage.
•Obtain the necessary paperwork and bill your
insurance carrier on your behalf.
•Explain which accessories are available at an
additional charge.
•Arrange delivery of the pump to you with free
standard shipping.
MPCS also provides wound care, urological, ostomy,
tracheostomy and diabetic care1 supplies, as well as
orthopedic products.
National Rehab Equipment, Inc. is now MPCS.
3 Easy Ways to Order a Breast Pump
Chat online at
mpcs.mckesson.com/breastpump
Fax or email order form
(inside) to 855.716.2212 or
BreastPumpCustomerService@
mckesson.com
Call 844.PCS.MOMS (844.727.6667)
Visit mpcs.mckesson.com/breastpump
for pump features.
Patient Information Section
Patient Name Date of Birth Expected Due Date Tel q Cell Phone
q Land Line
Email Shipping Address
Insurance Carrier ID# Group # Physician Information Section
Commonly used codes are listed below. If applicable, select one.
ICD-10 Codes
Postpartum Care and Examination
qZ
39.1
qO
92.5
Maintain Milk Supply/Prevent Suppressed Lactation
qO
92.70
Unspecified Disorders of Lactation
ther qO
Ordering Physician or Licensed Prescriber (Please Print)
Referral # Signature NPI# Date Breast Pump to be Ordered
q Double Electric Breast Pump (E0603)
q Other Quantity: q One q Other Frequency of Use and Duration of Use: Valid for
pregnancy with a due date of
/
/
To place order, fax form to 855.716.2212 or email t
Base Model
(Base models from other manufacturers also available.)
edela Pump In Style® Advanced
qM
Breastpump Starter Set (# 57081)
Double pumping kit includes:
•two medium breastshields
•two breastmilk bottles
•two lids
•power adaptor
Upgrade Models*
edela Pump In Style® Advanced
qM
Breastpump Tote
(# 57063)
edela Pump In Style®
qM
Advanced Breastpump Backpack
(# 57062)
q Medela Freestyle® Breastpump
(# 67060)
*Upgrade pump models or
accessories may be available at
additional charge.
to BreastPumpCustomerService@mckesson.com
McKesson Patient Care Solutions
Headquarters:
McKesson Patient Care Solutions Inc.
540 Lindbergh Drive
Moon Township, PA 15108
Medicaid beneficiaries may be required to contact their local Women, Infants and Children (WIC) office for coverage.
1
A s a result of regulatory changes effective July 1, 2013,
McKesson Patient Care Solutions Inc. is not able to provide
diabetic care supplies to patients using Medicare Part B benefits.
Email and online chat communications may not meet HIPAA
security standards. Please use care in emailing personal health
information and identifiable information suggested by this form.
All product claims, images and specifications are those of
the product suppliers, not McKesson Medical-Surgical or its
affiliates (“McKesson”) and have not been independently verified
by McKesson. They are provided solely for your convenience.
McKesson disclaims all responsibility for its completeness and
accuracy. Caution should be exercised when purchasing or using
any products by closely examining the product packaging and
the labeling prior to use.
All trademarks and registered trademarks are the property of their
respective owners.
© 2015 McKesson Medical-Surgical Inc.
All Rights Reserved
MPCS2015_0298