Abortions are only covered when the mother’s life is in danger or the pregnancy is the result of rape or incest. The attending physician must certify in writing that the abortion was performed because of one of the above criteria. Oral medications used to end a pregnancy may also be a covered benefit when the pregnancy is a result of rape or incest. Mifeprex and all associated services and supplies are covered only under the medical benefit. Misoprostol and all associated services and supplies may be covered through the medical benefit or through the TRICARE Pharmacy program.
Services or supplies related to spontaneous, missed or threatened abortions and abortions related to ectopic pregnancies may be covered.
An approval from HNFS is not required, except for active duty service members, however, a benefit review is recommended. The service must be ordered by the primary care manager (PCM) or specialist.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Visit our Abortion Billing Tips page to learn how to accurately submit claims.