New Lactation Codes Are Finally Dropping- But Who Are They Actually For?

FAQ and Action Steps

The American Medical Association (AMA) is rolling out new codes that can be used for lactation care. The broad interpretation would seem to allow standalone IBCLCs to use these codes, but a narrower interpretation might limit their use to physicians and the IBCLCs who work for them.

While we cannot get the code definitions changed, we can impact how they are interpreted and make sure that standalone IBCLCs (with or without state licensing) are permitted to use these codes in outpatient private practice.

We can do this by leaving public comments on the proposed rule by CMS (Center for Medicare & Medicaid Services) about how these codes will be paid.

We have until September 14, 2026 to leave comments for CMS about their proposed pricing for the new time-based lactation CPT (procedure) codes that the AMA will roll out in 2027.

Who created the new codes?

The AMA defines the CPT codes. They decide what services the codes encompass, and if there is any limitation on which providers can bill them. Specific insurance payers are allowed to place further restrictions on who can use these codes and under what circumstances.

What do the new codes pay?

CMS decides what Medicare will pay for these codes. State Medicaid programs and commercial payers will then use the Medicare fee schedule to set their own fee schedules. This means that it matters what CMS decides to pay even if you are not taking Medicaid plans.

What are the new codes?

These new codes are 978XX and 978X1, and cover “lactation care” for the first 30 minutes and then subsequent 15 minute increments as needed.

Who can bill the new codes?

The actual wording says “physician or other qualified health care professional.” This is where payers can determine for themselves who counts as qualified. Some payers view standalone IBCLCs as qualified; others do not.

The document also says that the lactation consultant must be recognized by an “appropriate source.” Most importantly this means we need to advocate for IBLCE to be recognized as an appropriate source and to make sure that IBCLCs (or their equivalent) do not need state licensure or physician supervision to provide lactation care.

How do we advocate and make our voices heard?

We can do this by responding to the direct question that CMS is asking:

“We… are seeking comment on whether Lactation Consultants are typically RNs with additional credentialing/certification to be qualified to serve as a lactation consultant.”

CMS needs to hear from every single one of you who is not an RN IBCLC before September 14th, 2026. Otherwise, they will put lactation consultants into the nursing bucket and allow payers to ignore any IBCLCs who do not hold a nursing license. The mechanism they are using is the way they are proposing to price these services.

Additionally, we should call attention to the way they are pricing this code, at a complexity level that would make sense for an inpatient lactation visit but not for the nuances of outpatient care. Essentially, CMS is saying that anything after the first 30 minutes doesn’t get paid because it’s deemed unnecessary or optional.

Here’s what I told them in my comment about what we do and why it takes so dang long:

Outside of the first 48 hours after birth, most lactation consults require significantly more time than the 15-30 minutes that a family may get in the hospital before discharge.

We typically spend 75-120 minutes with a family to have enough time to work with both the parent and the baby, observe a feeding, give counseling, education, referrals, and more.

Simply collecting the data from a weighted feed can take 45-60 minutes depending on how long the baby is feeding for.

The oral assessment portion must be done when the baby is rested and fed but not asleep, and can take 10-15 minutes.

A pump assessment and flange fitting is another 15-20 minutes. We do all of these things during an outpatient lactation consult.

After the visit, we are writing up a comprehensive care plan that encompasses both the parent and the baby and feeding goals.

We are sending reports back to the baby’s pediatrician and the parent’s care provider. We are often reviewing outside records and coordinating with specialists.

The encounters that run long are the complex ones: late preterm babies, multiple births, mastitis, bottle refusal, low milk supply, medically complex babies who need human milk, and more.

And since 1 in 5 birthing people will experience postpartum depression or anxiety (and 1 in 10 partners), a great deal of sensitivity is required to protect and support the parents’ mental health.

Direct comments matter the most

Yes, I know it takes more time to write your own comment than to sign on to someone else’s (like an online petition).

But individual comments that include real data and personal experience get noticed and can lead to real change.

I mean this. Near-identical mass comments get counted and set aside. Individual comments with real practice data get read, and sometimes get quoted back in the final rule.

How to file

1. Go to regulations.gov docket CMS-2026-2377 and click Comment. You do not need an account.
2. Introduce yourself with your name, your credentials, and where you practice.
3. Make sure to specify that you are commenting on this provision: Section (46), Lactation Care Services, CPT codes 978XX and 978X1, 91 FR 43890 to 43891.
4. Then provide your own answers to any or all of these points:
   • That becoming an IBCLC does not require you to be an RN first. Cite your own pathway if that applies to you.
   • Ask that the rule use an NCCA-accredited credential as the qualification standard. Here you can explain how hard you worked to become an IBCLC without a nursing background.
   • Explain that the work valuation does not accurately reflect the complexity of outpatient lactation care.
5. End with a personal story about how lactation care makes a difference in your community and how both RN IBCLCs and non-RN IBCLCs meet different needs in the lactation landscape. The rule should not privilege one over the other.

The actual text of the rule

Here is the lactation section in full. You can find it yourself by searching for the word “lactation” inside the full text.

(46) Lactation Care Services (CPT Codes 978XX and 978X1)

At the May 2025 CPT Editorial Panel meeting, two new CPT codes were created for reporting lactation care directed by a physician or qualified health care professional (QHP): CPT codes 978XX (Lactation care directed by a physician or other qualified health care professional, including history, assessment, training, and report; first 30 minutes) and 978X1 (Lactation care directed by a physician or other qualified health care professional, including history, assessment, training, and report; each additional 15 minutes). These new CPT codes were surveyed at the September 2025 AMA RUC Meeting.

For CY 2027, we are proposing the RUC-recommended work RVU of 0.18 for CPT code 978XX. The RUC did not recommend, and we are not proposing a work RVU for CPT code 978X1, which has been designed as a PE only service.

We are proposing the RUC-recommended direct PE inputs for CPT codes 978XX and 978X1, including the creation of a new clinical staff type for Lactation Consultant (L076A) and a new EF052 equipment item (scale, infant, digital, fine gradation). We are adopting CPT language and requirements for the Lactation Consultant: “The qualifications of the lactation consultant/counselor must be recognized by a physician society, nonphysician health care professional society/association, or other appropriate source.” We are proposing to value this new clinical staff type at the same 0.76 rate per minute currently used by the RN (L051A) clinical staff type as recommended by the RUC; we are seeking comment regarding this new clinical staff type and whether there may be a more appropriate crosswalk than the RN clinical staff type. We are proposing the RUC-recommendation of the RN clinical staff type as a proxy for pricing purposes, but are seeking comment on whether Lactation Consultants are typically RNs with additional credentialing/certification to be qualified to serve as a lactation consultant.

What in the actual what is an RVU?

RVU stands for Relative Value Unit. This is how Medicare gauges the worth of one service relative to every other service. The work RVU in particular is meant to capture the time, skill, mental effort, and stress involved.

Code 99213 (established patient, office visit, 20-29 minutes) has a work RVU of 1.3. By comparison, the new lactation code 978XX has a work RVU of 0.18. They are saying that a 30 minute lactation consult takes about one-seventh of the professional effort of a low complexity office visit. Literally saying we are sitting on our hands saying “good job mama” while a physician beams beneficently over our heads.

Even worse, the add on code 978X1 has no work RVU at all. Every minute past the first 30 is priced as practice expense only, meaning our time counts as staffing overhead (for example, rooming in or checking out) not clinical care.

978XX is being treated like a hospital encounter, not an outpatient lactation consult.

But Medicare doesn’t cover us

Doesn’t matter that they don’t cover us- they still have power over us. State Medicaid programs and commercial payers use the Medicare Physician Fee Schedule to set their own fee schedules. And they will often follow along with how CMS interprets the code description set by the AMA.

Sources

• The full proposed rule (search the page for “lactation”)
• Docket CMS-2026-2377 at regulations.gov
• CMS-1848-P landing page
• IBLCE certification pathways
• IBLCE current statistics on worldwide IBCLCs