Changes to TRICARE's Childbirth and Breastfeeding Support Demonstration

Wednesday, July 24, 2024

Since Jan. 1, 2022, TRICARE has allowed certified labor doulas (CLD), lactation consultants and lactation counselors to provide reimbursable care to TRICARE beneficiaries under the Childbirth and Breastfeeding Support Demonstration (CBSD). TRICARE has made changes to the CBSD, expanding doula certification options and creating a new Phase 2 for reimbursement. To bill under Phase 2, a CLD must be a network provider or have a signed non-network participation agreement on file. Phase 1 reimbursement, which does not require a participation agreement, remains only for dates of service prior to Jan. 1, 2025. We’ve updated our CLD non-network application to include a participation agreement. Find it on our Individual Provider Certification Applications page. Refer to TRICARE Operations Manual, Chapter 18, Section 11 and our CBSD page for more information.

What are the new accepted CLD certification bodies?

TRICARE now accepts CLD certification from the National Black Doulas Association. Additionally, TRICARE will accept Medicaid doula program participation in lieu of certification.

What is the new Phase 2 reimbursement?

Effective for dates of service on or after June 10, 2024, TRICARE has added HCPCS codes T1032 for antepartum and postpartum support visits and T1033 for the continuous labor support visit under the CBSD. HCPCS code T1032 will be reimbursed as
15-minute increments (a maximum of 24) combined for antepartum and postpartum visits per birth event. CLDs must be a network provider or have a signed non-network participation agreement on file to receive Phase 2 reimbursement.

Where can I find Phase 2 reimbursement rates?

Find current rates on the Military Health System's Childbirth Support Doula Services rates page. Rates vary by TRICARE locality.

What happens to Phase 1 reimbursement?

Non-network CLDs who have not signed a participation agreement may continue to bill using Current Procedural Terminology (CPT®) codes 59899 and 99509 for dates of service through Dec. 31, 2024. Phase 1 reimbursement will not be available for dates of service on or after Jan. 1, 2025.

What action, if any, do CLDs need to take?

For our network providers, no action is needed with HNFS. Non-network CLDs must submit the new CLD participation agreement to HNFS to get reimbursed under Phase 2 for dates of service June 10-Dec. 31, 2024. For dates of service on or after Jan. 1, 2025, CLDs will need to reach out to TriWest Healthcare Alliance.

Attend one of our CBSD webinars: Aug. 7, Aug. 14, Aug. 21, and Sept. 4. Visit our Online Education page to register.