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 only required for active duty service members who are prescribed a hospital-grade breast pump. All beneficiaries require a provider’s prescription 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.
Manual and electric breast pumps are covered for new mothers, including mothers who adopt an infant and plan to breastfeed. TRICARE covers one manual or electric breast pump per birth or adoption. The beneficiary must have a prescription from a TRICARE network or non-network physician, physician assistant, nurse practitioner, or nurse midwife.
The prescription must, at a minimum:
- Indicate the type of breast pump prescribed (manual, standard electric or hospital-grade electric) and
- Specify the number of weeks the beneficiary is pregnant or the age of the infant.
Currently, there are no restrictions on the brand or model of pump. However, the breast pump purchased must match the type of pump prescribed.
Heavy duty hospital-grade electric breast pumps may be covered as long as use is determined to be medically necessary and appropriate. When prescribing a hospital-grade breast pump, supporting medical documentation is required. (Active duty service members require HNFS approval for hospital-grade breast pumps.)
Note: When the hospital-grade breast pump is no longer needed, a manual or standard electric breast pump may be covered with a new prescription.
Breast Pump Supplies
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 unit = a set of 2 valves/membranes)
- 1 set (2) flanges/breast shields
- 1 set of tubing
- 90 breast milk bags every 30 days
A supplemental nursing system (SNS), two sets of nipple shields and additional replacement supplies in excess of the above limits may be covered with a prescription. The prescription must be specific to the supplies needed.
Services Not Covered
- baby weight scales
- breast pump batteries, battery-powered adapters and battery packs
- breast pump cleaning supplies
- extended warranties
- regular baby bottles (bottles not specific to pump operation), including associated nipples, caps and lids
- garments and other products that allow hands-free pump operation
- ice packs, labels, labeling lids, and other similar products
- nursing bras, bra pads, breast shells, and other similar products
- over-the-counter creams, ointments and other products that relieve breastfeeding related symptoms or conditions of the breasts or nipples
- travel bags and other similar carrying accessories
Beneficiaries are encouraged to use network providers who are required to file claims on their behalf. This will prevent beneficiaries from paying out-of-pocket up front and subsequently submitting claims for reimbursement.
Breast pumps and supplies can also be purchased through base commissaries, base/post/station exchanges, non-network providers, or any civilian stores (including online retailers) or pharmacies.
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.
The prescription must be included when submitting claims for breast pumps and supplies (when applicable) to HNFS. This prescription must specify the type of breast pump and indicate the number of weeks the beneficiary is pregnant or the age of the infant. A certificate of medical necessity is not required.
To be accurately reimbursed, providers billing for breast pump supplies using unlisted Healthcare Common Procedure Coding System (HCPCS) codes A9900 or A9999, should use the following modifiers. These modifiers will let HNFS know specifically which supplies were provided to the beneficiary.
|Replacement breast milk storage bags
|Replacement nipple shields
|Supplemental nursing system
|Breast pump kit
HNFS has coordinated with Humana Military, the TRICARE East Region contractor, to implement these same billing guidelines, as we recognize some breast pump supply companies operate on a national level.
Reimbursement will be the lesser of billed charges, negotiated rates or the Centers for Medicare and Medicaid Services durable medical equipment, prosthetics, orthotics and medical supplies fee schedule.
- Hospital-grade breast pumps are customarily rented. Once the rental cost has reached the purchase price, the provider must consider the item purchased and may not continue to bill rental charges.
- TRICARE covers standard shipping and handling charges for purchases made online.
View our claims page for more details on submitting claims.