Lactation Visit Receipt (LVR)
Lactation Visit Receipt (LVR)
"a lactation superbill"
P L E A S E R E A D OVER THIS PAGE CAREFULLY BEFORE ORDERING
I will not fill orders without your IBLCE # (I do verify these with www.iblce.org or www.ilca.org)!
You must have an EIN number and a NPI number before ordering, see below!
I have a strong ETHICAL commitment to the profession of IBCLC and to helping IBCLCs
with the forms necessary for professionalism.
 Creating
Professional
Excellence
for the
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 Revised Fall of 2009
Complete Packet is
Now Available on CD
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The Lactation Visit Receipt Packet
The LVR Packet is INTENDED for use by IBCLCs, doctors, nurse practitioners or other health care providers with at least IBCLC designation or greater.
If verification cannot be made of Board Certification through IBLCE or higher designation,
do NOT order, the order will not be filled.
International Board Certified Lactation Consultant ( IBCLC )
is the Gold Standard in lactation consulting.
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A note from Pat: I began my research into 3rd Party Reimbursement to design a superbill to meet my practice needs, I did a survey of about 30 LCs (most in private practice) to see what they thought was important in a lactation superbill. While doing the survey, there was so much interest in a new superbill with up-to-date coding that I was urged to make it available to others. This resulted in the Lactation Visit Receipt Packet. The LVR Packet has been reviewed by many of my peers and can be found in Linda Smith's book “The Lactation Consultant in Private Practice: The ABCs of Getting Started”, in Breastfeeding and Human Lactation, 3rd Edition, Jan Riordan, in ILCA's "Reimbursement Tool Kit" by Marsha Walker and in Medela's Messenger issue 20.1, 2003.
Use of the LVR does not guarantee reimbursement. This tool is used as a professional receipt for lactation service which is given to the consumer to file for insurance reimbursement, however, insurance reimbursement should never be guaranteed unless the provider has a contractual agreement with the consumer's insurance company and lactation are coved benefits on the consumer's insurance policy. The actual Lactation Visit Receipt is in a pdf so as many or as few copies as needed can be printed. You may want to print it out and take it to a printer such as Office Depot, Office Max or Staples for printing. The LVR is recommended to be printed in triplicate.....office copy, client copy and copy to be filed with insurance company (in my practice I keep original copy and
give client two copies so client can file for insurance reimbursement if they wish).
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A major revision of the Lactation Visit Receipt Packet was completed in October 2009. It can be Ordered On-line or order by
The complete packet is now available on CD-R.
If you have questions,
 E-mail at PatIBCLC@aol.com________________________________________________
The LVR Packet includes the following: |
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Customized Header on the 2011 version of Lactation Visit Receipt (Superbill) in pdf (with permission to print as many as you need)
A 20 page instruction booklet with details on filling out the LVR & basic reimbursement information in pdf
BONUS FORMS - Templates of the following in WORD:
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What others say about the LVR.....At ILCA 2002 Conference, Marsha Walker called the LVR Packet, a "fabulous reimbursement packet."
Voted in the top 5 Best Business Investments by 2003 Private Practice Lactation Consultant Conference
"Pat Lindsey's superbill is excellent !!!! ( thank you Pat ) and It is working. I am working part-time for a Family Practice doctor who does OB.
I use Pat's superbill and fax it to this docs biller. It does take me 1-2 months to get payment, however. Pat's superbill has been one of my best
investments as a professional Lactation Consultant." Star Siegfried,RN,BA,IBCLC 1 June 2002
"thank you so much for the superbill and forms. They are gold. : )" Diana West, IBCLC
"Hi Pat, I just wanted to let you know I got the CD. It was worth every penny! What a wealth of information you have put together. Excellent job.
I have my own version of many of these as I have been in private practice for 16 years. You really did an outstanding job. Thanks again."
Gail Macklin, RN, IBCLC 2011
Copies of LVR can be found in the following books:
ILCA's Reimbursement Tool Kit for Lactation Consultants by Marsha Walker
Breastfeeding and Human Lactation, Third Edition, page 54, by Jan Riordan and page, 33 of Fourth Edition.
The Lactation Consultant in Private Practice: the ABC's of Getting Started, page 326, by Linda Smith
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Three Options to Order the LVRP L E A S E R E A D OVER THIS WHOLE PAGE CAREFULLY BEFORE ORDERING
I will not fill orders without your IBLCE # (I do verify these with www.iblce.org or www.ilca.org)!
You must have an EIN number and a NPI number before ordering, see below!
I have a strong ETHICAL commitment to the profession of IBCLC and to helping IBCLCs
with the forms necessary for professionalism.
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PLEASE READ Before ordering:
A healthcare superbill is a professional receipt of services with the Current Procedural Terminology codes (CPT codes) and the International Classification of Diseases codes (ICD-9 codes). Professional healthcare providers use the superbill NOT to file insurance claims, but to give their clients a professional receipt of service. Most insurance companies require electronic claim filing from providers. The Lactation Visit Receipt can be used by the client to aid (not guarantee) in request
for insurance reimbursement from their medical insurance.
Insuance companies MUST have the healthcare providers mailing address (if you don't want to use your home address if you are doing home visits, you need to get a P.O. Box) and a phone number as well as your business National Provider Identification Number and a tax identification number (EIN) on the superbill to be considered for reimbursement. Insurance companies do NOT want emails or websites.
I am now recommending the Lactation Visit Receipt (superbill) to have an EIN, a NPI and the IBLCE-IBCLC number (if you are IBCLC).
If you do not have a National Provider Identifier (NPI) number as well as an Employee ID Number (EIN), you need to obtain these numbers. Both numbers can be applied for and obtained online without the help of an attorney or accountant. It usually only takes 1-3 days to get both.
1 - Employer ID Number (EIN) If you are a sole proprietor you might feel you don't qualify for an EIN based on what you read on the online page, just check the area that says you plan to have future employees (doesn't matter if you never plan to have employees). Healthcare insurance plans require EINs to process claims. You may apply online.
2 - National Provider Indentifier (NPI) - NEW REQUIREMENT FOR Healthcare providers to have a National Provider Identifier by MAY 23, 2007. USLCA highly encourages every IBCLC to have a NPI number and insurance company's require it to consider reimbursement on claims.
You may find out more and apply for NPI:
instructions for applying click at bottom of this page to start online application
Taxonomy codes to use in APPLYING for NPI are:
163WL0100X (for RN, IBCLC)
174N00000X (Lactation Consultant non-RN)
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The LVR Packet is INTENDED for use by IBCLCs, doctors, nurse practitioners or other health care providers with at least IBCLC designation or greater.
If verification cannot be made of Board Certification through IBLCE
or higher designation, do NOT order, the order will not be filled.
STEP 1) DO NOT FORGET THIS STEP (If you don't have your NPI an EIN, please wait till you do before ordering.)
Please email PatIBCLCPayPal@aol.com the information for the customized header of your Lactation Visit Receipt (SUPERBILL)
Example of information necessary to fill your order is below:
STEP 2) Pay for your order below.
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P L E A S E R E A D OVER THIS WHOLE PAGE CAREFULLY BEFORE ORDERING
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OPTION 1
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for institutions who need a
W-9 completed and signed for their
purchasing department.
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New Customers
Complete Lactation Visit Receipt Packet
on CD-R
$50.00
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OPTION 2
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Upgrade - Previous Customers
who have purchased an
earlier version
Complete Packet on CD-R
$35.00
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OPTION 3
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Upgrade - Previous Customers
Upgrading Lactation Visit Receipt ONLY
by E-mail
$20.00
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Effective October 1, 2009 - The most widely used Diagnoise IC-D 9 code changed
from 779.3 to 779.31 (feeding difficulties in newborn 28 day old or under).
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| 3 MUST for Every Private Practice IBCLC |
# 1 Click on book to order
from Hale Publishing
By Linda J. Smith & 15
private practice
contributing authors
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# 2
The Breastfeeding Atlas
 Click on book to order
from Hale Publishing
Click on book to order
from Hale Publishing
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# 3
 Click on book to order
from Hale Publishing
Click on book to order
from Hale Publishing
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© 200-2011 Pat Lindsey, IBCLC - Lactation Services all rights reserved.
This internet site provides information of a general nature.
If you have any concerns about your own health or the health of your child, you should
always consult with a physician or other healthcare professional.