Birthing Center Reimbursement
Thursday, August 8, 2019
Global maternity care under TRICARE includes prenatal care from the first obstetric visit, labor and delivery, postpartum care for up to six weeks after the birth of the child, and treatment of complications.
TRICARE-authorized freestanding or hospital-affiliated birthing centers that provide outpatient maternity care to TRICARE beneficiaries are reimbursed based on the lower of TRICARE’s established all-inclusive rate (network discounts may apply) or billed charges.
The all-inclusive rate includes services usually associated with a normal pregnancy and childbirth:
- certified nurse-midwife professional services,
- physician professional services (includes physician services for routine consultation when a certified nurse-midwife is the attending professional),
- birth assistant,
- laboratory studies,
- prenatal management,
- labor management,
- postpartum management,
- newborn care,
- and use of the facility.
The initial complete newborn examination by a pediatrician is not included in the birthing center all-inclusive fee.
Birthing centers that only provide part of the professional or facility services because the beneficiary moves and gets the remaining services elsewhere will only be reimbursed for that actual services provided as part of the all-inclusive rate.
For more information on birthing center reimbursement, please refer to the TRICARE Reimbursement Manual, Chapter 10, Section 1, paragraph 3.3. You may also visit our birthing center billing tips page for billing information.