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TRICARE® Updates Breast Pump and Supplies Benefit

Friday, April 12, 2019

TRICARE recently revised its breast pump and breast pump supplies benefit to specify when the benefit applies and to clarify the specific type of breast pumps and supplies covered. Breast pumps and related supplies are covered beginning at week 27 of pregnancy or the birth of child if prior to 27 weeks, and for female beneficiaries who legally adopt an infant and intend to personally breastfeed the adopted infant. 

Providers and beneficiaries do not need prior approval from Health Net Federal Services, LLC (HNFS), with the exception of active duty service members who continue to require HNFS approval for hospital-grade breast pumps. All beneficiaries must have a prescription from a TRICARE network or non-network physician, physician assistant, nurse practitioner, or nurse midwife. The prescription must specify the type of breast pump (manual, standard electric, hospital-grade electric) and the number of weeks the beneficiary is pregnant or the age of the infant. 

In addition, please note the following changes to TRICARE’s coverage of breast pump supplies, retroactive to July 5, 2018. 

Before July 5, 2018

  • Up to two breast pump kits per birth event.
  • The following supplies as necessary for up to 36 months after the birth event:
    • Standard power adapters
    • Tubing and tubing adaptors
    • Locking rings 
    • Bottles
    • Bottle caps
    • Shield/splash protectors
    • Storage bags used with the breast pump 

On or after July 5, 2018

  • One breast pump kit per birth event, to be included in the payment rate for the initial breast pump. Breast pump kits may not be separately reimbursed. 
  • The following replacement supplies (no additional prescription required):
    • Two replacement bottles and caps/locking rings every 12 months
    • One power adapter after the first 12 months 
    • 12 valves/membranes every 12 months
    • One set (2) flanges/breast shields
    • One set of tubing 
    • 90 breast milk bags every 30 days
  • The following supplies (separate prescription required):
    • One supplemental nursing system (SNS) per birth event
    • Two sets of nipple shields per birth event 

Note: Supplies in excess of these limits may be covered with a new prescription when medically necessary. The prescription must be specific to the supplies needed.

When submitting claims for breast pumps and supplies, the provider (or beneficiary) must include a copy of all required prescriptions. A certificate of medical necessity is not required. Find current reimbursement rate details at www.health.mil under the Durable, Medical Equipment, Prothetics, Orthotics, and Supplies (DMEPOS) pricing. 

Visit HNFS' Breast Pumps and Supplies Details page for more information.