Childbirth and Breastfeeding Support Demonstration Directory Updates
Thursday, April 7, 2022
As of Jan. 1, 2022, TRICARE allows for certified labor doulas (CLDs), lactation consultants and lactation counselors to provide reimbursable care to TRICARE beneficiaries under its Childbirth and Breastfeeding Support Demonstration (CBSD). In support of the demonstration, we now offer a CBSD Directory that allows beneficiaries and providers to search for network and non-network providers. Read more about the CBSD on our Childbirth and Breastfeeding Support Demonstration web page.
We continue to accept network and non-network providers for participation.
- Labor doulas, lactation consultants and lactation counselors must meet the certification requirements outlined in the TRICARE Operations Manual, Chapter 18, Section 11 in order to be reimbursed under the CBSD.
- Providers interested in joining the TRICARE West Region network may contact us for additional information and to request a Provider Participation Agreement (additional network requirements apply).
- Existing network groups that have these provider types should notify us via an updated roster.
- Non-network applications are available on our website. See the “Non-Network Provider” section of our Provider forms page.
Under the CBSD:
- Eligible beneficiaries can get up to six visits with a CLD before or after giving birth, as well as one continuous labor support encounter during the birth event. Beneficiaries must be at least 20 weeks pregnant and under the care of a TRICARE-authorized provider (for example, obstetrician, certified nurse midwife, etc.). Note: CLD services for beneficiaries who give birth at a military hospital or clinic are excluded from the CBSD.
- Eligible beneficiaries can also get up to six sessions of breastfeeding (lactation) counseling from a certified lactation consultant or counselor (six total, whether rendered under the CBSD or the TRICARE basic benefit).
Eligible beneficiaries do not need a referral for services under the demonstration when using network providers. Beneficiaries enrolled in TRICARE Prime will need a referral when using non-network providers to avoid point-of-service charges. There are no cost-shares, copayments or deductibles for covered services, but additional charges may apply if seeing out-of-network providers.
The following Current Procedural Terminology (CPT®) codes correspond to services under the CBSD. You can view reimbursement rates based on locality at www.health.mil/rates > CMAC > Procedure Pricing.
- 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); reimbursement rate is 15x the current locality-adjusted reimbursement rate for CPT code 99509.
CPT® is a registered trademark of the American Medical Association. All rights reserved.
CLD services not personally performed will not be reimbursed. The provider’s National Provider Identification (NPI) number must be on all claims. Visit our website for answers to frequently asked questions about the CBSD.