Breast milk bag modifier has changed

March 9, 2020

On January 1, 2020, Centers for Medicare and Medicaid Services (CMS) released a new Healthcare Common Procedure Coding System (HCPCS) code for use on breast milk storage.

  • Providers should use HCPCS code: K1005 for breast milk bag claims filed beginning on 1/1/2020.
  • Providers should use HCPCS codes: A9900 or A9999 using modifier –XH for breast milk bag claims filed prior to 1/1/2020.

If providers do not bill to the updated HCPCS code K1005 for claims after 3/1/2020, the claims will reject.

As a reminder, TRICARE allows 90 breast milk bags, every 30 days following a birth event. Providers must bill for the actual number of milk bags supplied (90), and not for a single (one) box of breast milk bags to get paid correctly.

Visit breast milk supplies for more information.