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Childbirth and Breastfeeding Support Demonstration

TRICARE will allow for certified labor doulas, lactation consultants and lactation counselors – currently excluded as TRICARE-authorized provider types under the TRICARE benefit – to provide reimbursable care to TRICARE beneficiaries under its Childbirth and Breastfeeding Support Demonstration. This is a five-year demonstration that starts on Jan. 1, 2022. 

  • Lactation counselors have received specialized training to aid in breastfeeding and infant nutrition from breastmilk, and generally provide breastfeeding counseling to support normal lactation and breastfeeding parents of healthy, full-term infants.

  • Lactation consultants have the highest level of breastfeeding training and may be necessary when complex problems surrounding breastfeeding arise.

  • Labor doulas, sometimes referred to as birth doulas, aid a birthing parent during the birthing process. They provide support for the birthing parent prior to, during and after labor. Labor doulas are not medical personnel and do not provide medical services, such as examination of the cervix or prescription of medications, and do not give medical advice. 

Please review the demonstration details below. We also offer a printable fact sheet for your use. 

Locating Providers

We will be updating our Network Provider Directory and Non-Network Directory to include these provider types. Beneficiaries and providers can contact us should they have questions about how to locate participating providers.

Lactation counselors, lactation consultants and labor doulas must meet the certification requirements outlined in the TRICARE Operations Manual, Chapter 18, Section 11 in order to be reimbursed under the demonstration. See "Provider Requirements" below.

  • Providers interested in joining the TRICARE West Region network may contact us for additional information. 
  • Existing network groups who have these provider types should notify us via an updated roster
  • Non-network applications are available on our “Non-Network Provider” forms page. 

Benefits 

  • Up to six sessions of breastfeeding (lactation) counseling from a certified lactation consultant or counselor (six total, whether rendered under the demonstration or the TRICARE basic benefit by a TRICARE-authorized provider such as a physician, physician assistant, nurse practitioner, certified nurse midwife, registered nurse, outpatient hospital or clinic). 

  • Up to six visits by a certified labor doula (CLD) services before or after giving birth for pregnant beneficiaries who are at least 20 weeks and under the care of a TRICARE-authorized provider (for example, obstetrician, certified nurse midwife, etc.), as well as one continuous labor support encounter during the birth event. 

This demonstration will not be offered at a military hospitals and clinics.

Referrals

TRICARE beneficiaries do not need a referral for services under the demonstration. For TRICARE Prime beneficiaries, Point of Service charges may apply for care received by non-network providers without a referral.  

Costs

Cost-shares, copayments and deductibles don’t apply to covered breastfeeding/lactation counseling services (see Point of Service note above). 

Provider Types/Requirements

Lactation counselors, lactation consultants and labor doulas must meet the certification requirements outlined in the TRICARE Operations Manual, Chapter 18, Section 11 in order to be reimbursed under the demonstration. Providers interested in joining HNFS’ TRICARE West Region network may contact us for additional information (additional network requirements apply). Non-network applications are available on our “Non-Network Provider” forms page. 

Lactation consultants, lactation counselors and certified labor doulas must:

  • Be at least 18 years old.
  • Have/maintain a current adult, child, and infant CPR certification.
  • Have a National Provider Identification (NPI) number.
  • Have malpractice insurance in amount of $200k/$600k
  • Not have any current Medicare or Medicaid sanctions
  • Not have any unexplained gaps in work history for the most recent five (5) years
  • Be licensed/certified by one of the acceptable boards as noted in the table below (if offered within the state, must also have state license/certification) 

Certified labor doulas must also:

  • Have attended a minimum of 24 education hours to include:
    • the physiology of labor;
    • labor doula training;
    • antepartum doula training; and
    • postpartum doula training.
  • Have attended one or more breastfeeding courses.
  • Have attended one or more childbirth classes.
  • Not have obtained education/experience during the CLD’s own pregnancy/childbirth or the childbirth of an immediate family member.
     

Acceptable Boards

Provider Type Board
Lactation Counselor
  • ALPP-certified as an Advanced Lactation Consultant or Advanced Nurse Lactation Consultant
Lactation Consultant
  • IBCL-certified as an International Board-Certified Lactation Consultation; or
  • ALPP-certified as an Advanced Lactation Consultant or Advanced Nurse Lactation Consultant

Certified Labor Doula

Postpartum doula certification by itself does not qualify. 

Additional Requirements (must sign attestation):

  • Provided continuous in-person childbirth support for at least three childbirths, with a minimum of 15 hours over the three childbirths 
  • At least two of the three births were a vaginal birth
  • Provided antepartum and postpartum support for at least one birth

Reimbursement

  • Individual lactation counseling sessions: CPT® 99401 (15 min.); 99402 (30 min.); 99403 (45 min.); 99404 (60 min.)
  • Group lactation consulting: CPT 99411 (30 min.) and 99412 (60 min.)
  • Antepartum and postpartum visits: CPT 99509 (untimed, up to six combined antepartum and postpartum visits)
  • Continuous labor support visits: CPT 59899 (untimed, one per birth event) 

Certified labor doula services not personally performed will not be reimbursed.

The provider’s National Provider Identification (NPI) number must be on all claims. To learn more about NPIs, visit our NPI page. Also see "Taxonomies" below. 

View current rates at www.health.mil/rates.

Taxonomies

  • Lactation Consultant
    • Non-RN – 174N00000X
    • RN (Lactation Consultant) – 163WL0100X
  • Doula – 374J00000X
  • Lactation Counselor – 174400000X (will show as "Specialist" in the NPI registry)


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