Breast Pumps and Supplies Reimbursement
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.
Breast pump supplies included with the initial breast pump are not eligible for separate reimbursement. Effective July 5, 2018, the following replacement supplies are covered without an additional prescription:
- 2 replacement bottles 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.
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.