Does TRICARE Cover Doula Services?

Doula services offer valuable support to individuals during the transformative period of pregnancy, childbirth, and the initial postpartum phase. These non-medical professionals provide emotional reassurance, physical comfort techniques, and informational guidance, helping to empower birthing individuals and their families. A doula’s presence can contribute to a more positive and informed birth experience. This support complements the medical care provided by healthcare practitioners, focusing on the holistic well-being of the birthing person.

TRICARE’s Doula Service Coverage

TRICARE covers doula services through the Childbirth and Breastfeeding Support Demonstration (CBSD) until December 31, 2026. The coverage includes specific services designed to assist beneficiaries throughout their perinatal journey.

Beneficiaries can receive up to six hours of antepartum (prenatal) and/or postpartum visits from a certified labor doula. These visits are timed in 15-minute increments, allowing flexibility in how the hours are utilized. Additionally, the demonstration covers one continuous labor support visit, which is untimed and applies regardless of the labor’s duration or the delivery method, including vaginal births or Cesarean sections.

The demonstration specifically covers birth doulas. Services are generally required to be in-person, though virtual consultations for antepartum and postpartum periods may be permitted. Furthermore, doula services are not covered under this demonstration if the birth takes place in a military hospital or clinic.

For billing purposes, Certified Labor Doulas (CLDs) utilize specific Current Procedural Terminology (CPT) codes. Antepartum and postpartum support visits are typically billed using CPT code T1032. The continuous labor support visit is billed with CPT code T1033.

Eligibility and Provider Requirements

Beneficiaries enrolled in TRICARE Prime, TRICARE Select, and TRICARE Prime Remote are eligible for doula services under the Childbirth and Breastfeeding Support Demonstration. This coverage extends to those residing in the U.S., District of Columbia, U.S. territories, and, as of January 1, 2025, overseas. To qualify for doula support, beneficiaries must be at least 20 weeks pregnant at the time of their first prenatal visit.

Beneficiaries must plan to give birth outside of a military treatment facility. The birth event must also be managed by a TRICARE-authorized provider, such as an obstetrician-gynecologist (OB/GYN) or a Certified Nurse Midwife (CNM).

Doulas seeking to be covered providers under TRICARE must meet specific qualifications to be recognized as Certified Labor Doulas (CLDs). Certification must come from an approved organization. Participation in a statewide Medicaid doula program may also substitute for the certification requirement.

Doulas must complete a minimum of 24 education hours covering labor physiology, labor doula training, antepartum doula training, and postpartum doula training. They must also have experience providing continuous in-person childbirth support for at least three births within the last three years, totaling a minimum of 15 hours, with at least two of these being vaginal births and support for both antepartum and postpartum periods for one birth. Additional requirements include being at least 18 years old, holding a current adult, child, and infant CPR certification, obtaining a National Provider Identification (NPI) number, and possessing professional liability insurance. Doulas in the U.S. must also sign a participation agreement to be eligible for reimbursement.

Accessing Services and Claim Submission

Finding a TRICARE-authorized doula involves utilizing specific resources provided by the TRICARE system. Beneficiaries can begin their search using TRICARE’s online provider search tool. Alternatively, they can visit the websites of their regional contractors, such as Humana Military for the East Region or TriWest Healthcare Alliance for the West Region, where provider directories are available.

When searching, look for “Certified Labor Doula” or “Doula” under the medical specialists category. If direct results are limited, contacting the regional contractor directly can provide a list of approved providers in the area. While some doulas may be in-network, others might be non-network, and beneficiaries have the option to choose either.

Regarding referrals, TRICARE Select beneficiaries generally do not need a referral to access doula services. However, TRICARE Prime beneficiaries require a referral from their Primary Care Manager (PCM) if they choose to see a non-network doula; failure to obtain this referral may result in point-of-service charges. No referral is typically needed for TRICARE Prime beneficiaries using an in-network doula.

For claim submission, doulas generally bill TRICARE directly for covered services, meaning beneficiaries should not incur upfront out-of-pocket costs for these specific services. However, if a beneficiary uses a non-participating provider or is in certain travel situations, they may need to file the claim for reimbursement themselves. The primary form for beneficiary-filed claims is the TRICARE DoD/CHAMPUS Claim Form (DD Form 2642).

When submitting a claim, beneficiaries must complete DD Form 2642 in its entirety and attach a readable, itemized bill from the doula. This bill should clearly state the provider’s name and address, the date and place of each service, a description of the services furnished, the charge for each service, and the diagnosis. Claims can be submitted to the regional contractor via mail or, in some cases, through an online portal, particularly for overseas claims. Claims generally have a timely filing limit of one year from the date of service, though overseas claims may have a three-year limit.