Breast Pumps, Breast Pump Supplies and Banked Donor Milk Reimbursement
Breast Pumps and Supplies
Breast pumps and breast pump supplies are a TRICARE covered benefit beginning at week 27 of pregnancy or the birth of a child if prior to 27 weeks, and for female beneficiaries who legally adopt an infant and intend to personally breastfeed the adopted infant.
An approval from Health Net Federal Services, LLC (HNFS) is not required. However, a provider’s order or prescription is required for reimbursement. The prescription must include the type of breast pump needed and specify the number of weeks the beneficiary is pregnant or the age of the infant.
One breast pump kit is covered per birth event, but may not be reimbursed separately. Effective July 5, 2018, the following replacement supplies are covered without an additional prescription:
- 2 replacement bottles and caps/locking rings every 12 months,
- 1 power adapter after the first 12 months,
- 12 valves/membranes every 12 months,
- 1 set (2) flanges/breast shields,
- 1 set of tubing, and
- 90 breast milk bags every 30 days.
A supplemental nursing system (SNS), two sets of nipple shields and additional replacement supplies may be covered with a prescription.
View TRICARE’s Breast Pumps and Supplies Frequently Asked Questions page for detailed benefit information.
Note: Due to systems updates required for this new benefit we are carefully reviewing each claim to ensure proper payment. Please allow for longer than usual processing times on breast pump and breast pump supply claims.
Network providers must submit claims for TRICARE beneficiaries. Beneficiaries who purchase breast pumps/supplies from non-network providers, civilian stores or retail pharmacies can submit claims to HNFS for reimbursement. A copy of the prescription must be included with the claim. Visit our Submit a Beneficiary Claim page for details on how to submit claims.
Copayments and Cost-Shares
Copayments, cost-shares and deductibles are not applied to breast pumps, supplies and breastfeeding counseling.
Reimbursement rates can be viewed at www.health.mil under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) pricing.
These reimbursement rates are subject to change annually.
Banked Donor Milk
Banked donor milk is a limited TRICARE benefit when medically necessary. Coverage includes up to 35 ounces per day per infant. The donor milk must come from a milk bank accredited by the Human Milk Banking Association of North America (HMBANA). Visit TRICARE's Covered Services page to learn more about coverage limitations and requirements.
An approval from HNFS is not required. However, all beneficiaries must obtain a prescription from the doctor actively managing their/their infant’s treatment. The initial prescription is valid for 30 days. Coverage may be extended in 30-day intervals through 12 months of age, when medically necessary and with a new prescription.
- If the HMBANA-accredited milk bank files a claim on your behalf, it must include a copy of the prescription and supporting medical documentation (available from the prescribing provider) with the claim.
- If you purchase banked donor milk from a non-network provider, you can submit the claim to HNFS for reimbursement. A copy of the prescription must be included with the claim.
Visit our Submit a Beneficiary Claim page for details on how to submit claims.