Lactation Care Is at a Crossroads. Our Voices Need to Be Heard.

By Kaylee Costa, MBA, IBCLC, PMH-C, CHW | September 8, 2026

There is a lot happening in the lactation world right now, and these lactation insurance changes are affecting the families we serve in very real ways.

Lactation Care Is at a Crossroads. Our Voices Need to Be Heard.

UnitedHealthcare’s reimbursement changes, proposed CMS codes, and why the future of accessible lactation care matters to every family.

There is a lot happening in the lactation world right now, and I think the families we serve deserve to know about it.

On September 1, UnitedHealthcare implemented a policy change that stops reimbursing lactation counseling code S9443 when the claim is submitted under the infant. At the same time, the Centers for Medicare & Medicaid Services (CMS) is considering how new lactation care codes should be valued for 2027, including whether the work of a lactation consultant should be priced using a registered nurse as a clinical staffing proxy.

These are two separate policy developments, but they raise the same larger question: How do we make lactation care accessible, recognize the professionals providing it, and create a system that allows that care to remain sustainable?

For me, this is not an abstract policy discussion. It is happening in my practice, with families I care about, right now.

The UnitedHealthcare change is already affecting real families

UnitedHealthcare’s June 2026 reimbursement bulletin states that, effective September 1, code S9443 will be considered for reimbursement when the mother is listed as the patient, but not when an infant is listed as the patient. The policy also limits reimbursement to one session per date of service.

This does not mean UnitedHealthcare has eliminated every form of medical coverage for infants. It means a specific lactation counseling reimbursement pathway that has been used for infant care is no longer available in the same way.

That distinction matters, but it does not make the impact any less concerning.

Lactation care is not simply watching a baby feed. It is the clinical assessment of a feeding relationship involving two people.

If a mother is experiencing nipple pain, I need to assess what is happening when her baby feeds. If a baby is struggling to gain weight, I may need to evaluate milk transfer, oral function, maternal milk production, pumping, and the overall feeding plan. The care is interconnected because the physiology is interconnected.

A billing system may separate mother and baby into two individual patients. Clinically, we cannot pretend their feeding concerns exist independently of one another.

This week, I had no answers for my own client

I have a follow-up visit this week with a mother and baby I have been working with to help them establish a latch. She has been pumping while we continue working toward that goal.

She has UnitedHealthcare.

When we discussed the policy change, I had to tell her that I genuinely did not know what would happen next. I could not give her a clear answer about how the claim would be processed, whether any cost-sharing might be imposed, or whether a deductible could come into play.

I assured her that if a charge came back to my practice that I could control, I would zero it out rather than pass that unexpected expense along to her. I could not promise how her insurance plan would process any separate member responsibility, but I wanted her to know that I was not going to casually hand her a bill for a change she had no part in creating.

The truth is, I am not in a financial position where I can simply absorb lost reimbursement. I am a small, independent practice owner. I have business expenses, a family, and a practice that needs to remain sustainable.

But I also know what it feels like to be a mother trying to get help for her baby. I know how much work this family has already put into their feeding journey. And I could not imagine telling her that, after all of that, she might suddenly have to pay more because an insurer changed the way it reimburses our care.

That is the difficult position many lactation professionals are now facing.

Some practices may have to introduce a self-pay fee for the infant portion of a visit. Others may absorb the loss, change their visit structure, or reconsider whether they can continue accepting certain insurance plans. These are not easy decisions, and they are not evidence that providers care less about accessibility.

A business cannot provide a clinical service for free indefinitely and still remain open.

My practice was built around accessibility. I accept insurance because families deserve lactation care without needing hundreds of dollars upfront. I have done that knowing reimbursement was never going to make me rich.

That was never the point. The point was access.

Why the CMS proposal matters, too

While we are navigating these immediate reimbursement changes, CMS is also considering two new lactation care CPT codes for the 2027 Medicare Physician Fee Schedule.

The proposed codes, currently identified as 978XX and 978X1, describe lactation care directed by a physician or other qualified health care professional. CMS is proposing a new clinical staff category specifically for lactation consultants and is seeking public comments on how that category should be valued.

That recognition is important. Having a specific category for lactation care is a meaningful step toward acknowledging the work we do.

But the details matter.

CMS is proposing to use the registered nurse clinical staff rate as a pricing proxy and is asking whether lactation consultants are typically RNs with additional credentialing or certification. It is also asking whether a more appropriate comparison exists.

This is where our profession needs to be heard.

An IBCLC is not simply an RN with additional training.

Some IBCLCs are registered nurses. Many are not. Nursing is not a prerequisite for becoming an International Board Certified Lactation Consultant.

There are three established pathways to IBCLC certification: clinical experience through an appropriate supervised setting, an accredited lactation academic program, or a structured mentorship pathway. Candidates must meet the applicable education and clinical requirements and pass the international certification examination.

The IBCLC credential is a specialized, independently accredited credential in lactation and breastfeeding care. It is not an extension of nursing licensure.

Many of the clinicians, educators, researchers, and mentors who have shaped our profession are not RNs. Their expertise is no less valuable because they entered lactation care through a different professional background.

This is not RN IBCLCs versus non-RN IBCLCs. Both bring important expertise, and both deserve recognition. The issue is whether the credential itself is being accurately represented and whether the resources required to provide lactation care are being appropriately valued.

An RN may bring additional nursing expertise to their practice. A non-RN IBCLC may bring expertise from public health, nutrition, counseling, education, or another field. What they share is the specialized lactation credential and the clinical competencies required to earn it.

We should not have to privilege one background over another in order to demonstrate the value of our profession.

What does a lactation consultation actually involve?

A comprehensive lactation visit may include reviewing the parent’s and infant’s health and feeding history, assessing milk production and transfer, evaluating latch and positioning, identifying pumping or flange-fitting concerns, assessing infant feeding function, developing an individualized care plan, recognizing when referrals are needed, and coordinating with other healthcare professionals.

It also involves clinical judgment, documentation, follow-up, and responsibility for recognizing when something is outside our scope and requires additional evaluation.

That work takes time. It requires specialized education, clinical experience, and ongoing professional development.

The proposed CMS codes are not yet a guarantee of independent Medicare billing privileges or universal insurance coverage. They are part of a developing payment framework. That is precisely why it is important to provide accurate information now, while CMS is still asking questions.

The assumptions used to value our work today can influence how lactation care is recognized and reimbursed in the future.

If insurance covered your lactation care, please pay it forward

This is the part I am asking every family to consider.

If you were able to see a lactation consultant because your insurance covered the visit, please think about what that access meant to you.

Maybe you were struggling with pain and did not know whether you could continue breastfeeding. Maybe your baby was not transferring enough milk. Maybe you were exclusively pumping, working through bottle refusal, trying to increase supply, or simply needed someone to sit with you and help you understand what was happening.

Maybe insurance coverage meant you could get help without having to choose between a lactation visit and another household expense.

If that support made a difference in your journey, please pay it forward for the next mom.

You do not have to be an IBCLC. You do not have to be a nurse. You do not have to understand medical billing or write a technical policy analysis.

You can submit a public comment to CMS and explain why accessible lactation care matters.

Tell them that IBCLCs are not simply nurses with additional training. Tell them that the IBCLC credential represents specialized expertise in lactation and breastfeeding care. Tell them what your lactation consultant did for you, and why being able to access that care through insurance mattered to your family.

Your personal experience is part of the evidence of why this care matters in real life.

How to submit your comment

CMS is accepting public comments on the proposed 2027 Medicare Physician Fee Schedule through September 14, 2026. Anyone may submit a comment, and you do not need to have Medicare or be a healthcare professional.

Visit Regulations.gov and search for docket CMS-2026-2377.
Select the option to submit a comment on the proposed rule.
Identify Section (46), Lactation Care Services, CPT codes 978XX and 978X1, and explain your concerns or personal experience.

You can include your name, credentials if applicable, and practice location. If you are a parent, share how lactation care affected your family and why insurance coverage made a difference. If you are a clinician, explain your training, the complexity of your work, and why the IBCLC credential should be recognized independently of RN licensure.

Your comment does not need to be long or perfectly written. A thoughtful paragraph is enough to make your voice part of the public record.

What I hope we can build from this moment

I do not want this conversation to become a fight between nurses and non-nurses, or between families and the small businesses trying to serve them.

I want it to be a conversation about what our healthcare system claims to value.

We talk about preventive care, maternal health, infant health, health equity, and improving outcomes. Lactation support is part of all of those conversations. It helps families address feeding problems, protect milk supply, manage pain, and identify concerns that may require further care.

We cannot say that care is important and then make it increasingly difficult for families to access or for qualified professionals to provide.

UnitedHealthcare has made its reimbursement decision. CMS is still asking questions about how lactation care should be valued.

We have an opportunity to make sure those questions are answered by the people who actually provide and receive this care.

If insurance helped you access lactation support, please help protect that opportunity for the next family.

Our profession deserves to be recognized. Our work deserves to be valued.
And the families we serve deserve to be heard.

Kaylee Costa, IBCLC, PMH-C, CPST, CHW
Costa Consultation | Where wellness meets motherhood

This article reflects the policy information available as of September 8, 2026. Insurance benefits and individual claim outcomes vary by plan, and the CMS provisions discussed above remain proposed rather than final.