New claims modifiers for breast pump supplies

Update: October 7, 2019

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


June 26, 2019

TRICARE recently revised the breast pump/breast pump supply benefit to include limits on what is covered. The changes affirm coverage of breast pumps for new mothers and adoptive mothers and allow expecting moms to access the benefit starting at the 27th week of pregnancy, or when the baby is born, if premature.

In order to correctly reimburse for breast pump supplies using unlisted Healthcare Common Procedure Coding System (HCPCS) codes A9900 or A9999, providers need to use the following modifiers:

The new policy allows only the breast pump and the following replacement parts without an additional prescription:

  • Two bottles and caps or locking rings once a year after a birth event
  • One replacement power adapter per birth event and none within the first 12 months
  • 12 valves or membranes once a year
  • One set of flanges per birth event
  • One set of tubing
  • 90 breast milk bags every 30 days after the birth

Both the TRICARE East and TRICARE West regions are implementing these guidelines.

A supplemental nursing system, two sets of flanges and replacement supplies in addition to the above limits may be covered with a prescription that is specific to the supplies that are needed.

Additionally, TRICARE added a payment cap for manual and standard electric breast pumps. All related supplies needed for the operation of the breast pump are included in the cap amount. As of March 2019, TRICARE pays $312.84 for stateside and $500.55 for overseas. For more about these rates, visit health.mil