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Breast Pumps and Supplies Billing Tips

See our Breast Pumps and Supplies page for benefit information and approval requirements. 

Prescription Requirement

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.

  • In lieu of creating a specific prescription form, the referring provider can complete our Breast Pump and Supplies Prescription form and submit it with the claim.
  • A certificate of medical necessity is not required unless you exceed the quantity limits listed below.

Billing and Reimbursement

To be accurately reimbursed, providers billing for breast pump supplies using unlisted Healthcare Common Procedure Coding System (HCPCS) codes A9900 or A9999. You must also include the following modifiers. These modifiers will let HNFS know specifically which supplies were provided to the beneficiary.

Supply Type Modifier Quantity Limits (Without Prescription)
Replacement valves/membranes XG 12 every 12 months (6 pairs/units)
Replacement breast milk storage bags XH* 90 individual bags every 30 days
Replacement nipple shields XD 2 sets (2 shields per set) every birthing event
Supplemental nursing system XN 1 every birthing event
Breast pump kit SR 1 every birthing event

*Beginning April 1, 2020, HNFS will only accept procedure code K1005 on claims for breast milk storage bags with dates of service on or after Jan. 1, 2020. Claims received on or after April 1 with the unlisted HCPCS code A9900 or A9999 and modifier XH will be denied. Note, this update does not pertain to other breast pump supplies.


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.

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.  

Supply Type Modifier Quantity Limits (Without Prescription)
Replacement valves/membranes XG 12 every 12 months (1 unit = a set of 2 valves/membranes)
Replacement breast milk storage bags XH 90 individual bags every 30 days
Replacement nipple shields XD 2 sets (2 shields per set) every birthing event
Supplemental nursing system XN 1 every birthing event
Breast pump kit XR 1 every birthing event

 

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.

Supply Type Modifier Quantity Limits (Without Prescription)
Replacement valves/membranes XG 12 every 12 months (1 unit = a set of 2 valves/membranes)
Replacement breast milk storage bags XH 90 individual bags every 30 days
Replacement nipple shields XD 2 sets (2 shields per set) every birthing event
Supplemental nursing system XN 1 every birthing event
Breast pump kit XR 1 every birthing event

 

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.