Childbirth and Breastfeeding Support Demonstration: Claims and Reimbursement

Breastfeeding Support Services (Lactation)

View current rates at www.health.mil/rates > CHAMPUS Maximum Allowable Charge Rates (rates vary by locality).

Individual Lactation Consulting

• CPT^® code 99401 – 15 minutes
• CPT code 99402 – 30 minutes
• CPT code 99403 – 45 minutes
• CPT code 99404 – 60 minutes

Group Lactation Consulting

• CPT code 99411 – 30 minutes
• CPT code 99412 – 60 minutes

If rendered via telehealth, include the appropriate modifier (GT or 95)

*Services limited to six visits total

Phase 1 Reimbursement – Effective for dates of service Jan. 1, 2022-Dec. 31, 2024

View current rates at www.health.mil/rates > CHAMPUS Maximum Allowable Charge Rates (rates vary by locality). 

Antepartum and Postpartum

• CPT code 99509
• Six visits total
• Support is untimed and is per single birth event
• Place of service (POS) is limited to residence/home (POS-12)

Continuous Labor Support

• CPT code 59899
• Reimbursement is 15 x CPT code 99509
• Support is untimed and is per single birth event
• Care is not covered at military hospitals or clinics
• POS is limited to:
  • Hospital (POS-21)
  • Birthing center (POS- 22)
  • Home (POS- 12)

Phase 2 Reimbursement – Available for dates of service on or after June 10, 2024*

View current rates at www.health.mil/rates > Childbirth Support Doula Services (rates vary by locality).

Antepartum and Postpartum

• HCPCS code T1032
• Maximum of 24, 15-minute increments combined for antepartum and postpartum visits per birth event

Continuous Labor Support

• HCPCS code T1033
• Untimed
• One continuous labor support visit per birth event

*CLD must be in-network or have a signed participation agreement on file to receive Phase 2 reimbursement. Refer to our Provider Participation page for more information.

Please note:

• CLD services are not covered for beneficiaries who give birth in military hospitals or clinics. 
• Telehealth visits are not covered for doula services.
• CLD services not personally performed will not be reimbursed.