Breast Pumps and Supplies
Breast pumps and breast pump supplies are a TRICARE covered benefit beginning at week 27 of pregnancy (third trimester) 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.
- In lieu of creating a specific prescription form, the referring provider can complete our Breast Pump and Supplies Prescription form.
Breast Pumps
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.
Cost Information: Cost-shares, copayments and deductibles do not apply to covered manual or standard electric breast pumps. Find current reimbursement rates at https://health.mil.
Breast Pump Supplies
One breast pump kit is covered per birth event, but may not be reimbursed separately. The following replacement supplies are covered without an additional prescription:
- 2 replacement bottles and caps/locking rings every 12 months
- 1 replacement power adapter after the first 12 months (HCPCS A4282)
- 12 individual valves/membranes every 12 months (6 pairs/units)
- 1 set (2) flanges/breast shields
- 1 set of tubing
- 100 breast milk bags every 30 days (100 individual bags, not boxes)
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.
HNFS must have processed for payment the related breast pump claim before we can accept the claim for supplies. Exception: If the breast pump was not prescribed (gift, previously purchased, etc.), attach a Certificate of Medical Necessity indicating as such so we may process the breast pump supplies claim for reimbursement.
Unbundling a breast pump kit and billing the items individually in order to maximize reimbursement is considered an abusive billing practice. See TRICARE Policy Manual, Chapter 8, Section 2.6, paragraph 5.5 for details.
Cost Information: Cost-shares, copayments and deductibles do not apply to covered breast pump supplies. Find current reimbursement rates at https://health.mil.
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
Providers
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.
Additional Information
