UPDATE: ALPP's Director, Ellie Mulpeter, was contacted on July 8, 2026 by PGBA (Palmetto Government Benefits Administrator) an insurance administration and claims processing company. They notified ALPP that the claims being denied were a result of a system error, which has since been corrected. They also notified ALPP that all claims that were incorrectly denied are being re-processed as high priority claims. If any lactation professionals face future denials of claims using CPT Codes 99401 to 99404, those professionals should contact ALPP for further assistance at: info@alpp.org

A copy of ALPP's letter, sent on Thursday July 2, 2026, can be found below:

To TRICARE West, TRICARE East, TRICARE Overseas, PGBA and the Defense Health Agency,

The Academy of Lactation Policy and Practice (“ALPP”) has been notified of a pattern of denial of claims for lactation counseling and lactation consulting across all TRICARE regions – directly and negatively impacting military families across the U.S. and overseas. Reimbursement for lactation services is a required benefit under the TRICARE childbirth and breastfeeding support demonstration (“CBSD”) project. Per that project, TRICARE recognizes lactation counseling as good clinical practice, and commits to covering breastfeeding counseling at no cost when provided inpatient, outpatient and during well-child care visits, for up to six separate outpatient sessions, as a preventative service. Lactation support services are to be provided by International Board Certified Lactation Consultants (“IBCLC®”) and Certified Lactation Counselors (“CLC®”).

Per Chapter 18 of the TRICARE Operation Manual for the CBSD project, “The contractor shall reimburse individual lactation counseling sessions under the existing TRICARE breastfeeding support benefit, at the non-physician, non-facility CHAMPUS Maximum Allowable Charge (“CMAC”) under the existing Current Procedural Terminology (“CPT”) codes 99401 to 99404.”[1] Meanwhile, we have evidence of a systematic pattern of TRICARE claim denials, beginning in May 2026, for services billed under CPT Codes 99401-99404, with no legitimate policy basis.

Breastfeeding support is critical after a mother and baby leave a hospital or birth center following childbirth. The majority of individuals seek follow-up care, support and guidance for how to successfully sustain and maintain breastfeeding their baby. The public health benefits of breastfeeding are vast. Empirical data has shown that exclusive breastfeeding for 6 months, and continued breastfeeding alongside complementary foods for two years or beyond can prevent the following cases among infants and young children:

• 45,298 cases of childhood obesity[2]
• 601,825 ear infections in children[3]
• 1,355 cases of necrotizing enterocolitis[4]

Optimal breastfeeding could also reduce diseases among women by preventing:

• 5,023 cases of breast cancer[5]
• 12,320 cases of Type 2 diabetes[6]
• 5,982 cases of hypertension[7]

The value of the CBSD project cannot be understated for military families, but it will only be beneficial to military families if its own payment and claims systems are consistent and reliable. Lactation professionals consistently have to advocate for reimbursement of their services and time, and typically have to settle for a reimbursement amount that does not adequately align with the work they are doing. The CBSD project cannot fall into this same pitfall. There is no reason why these claims are being denied.

Military members and their families already sacrifice for our country; they should not have to sacrifice being able to receive the care that the DHA have committed to. We urge TRICARE to reverse the denials of claims for codes 99401 to 99404 that have been issued over the past two, successive months. We urge TRICARE to allow the use of billing codes, as outlined in their manuals, or to issue clear guidance on which codes lactation professionals should use under the CBSD project, while setting an effective date for the change in the future, and honoring the use of “grandfathered” CPT codes for a set period of time.

Sincerely,
Ellie Mulpeter, MPH
Director, Academy of Lactation Policy and Practice
E: info@alpp.org


[1] https://manuals.health.mil/pages/DisplayManualHtmlFile/2024-03-18/AsOf/TO15/C18S11.html
[2]Finkelstein, E.A., Graham, W.C., & Malhotra, R. (2014). Lifetime direct medical costs of childhood obesity. Pediatrics, 133(5): 854-62.
[3]Ahmed, S., Shapiro, N., & Bhattacharyya, N. (2014). Incremental health care utilization and costs for acute otitis media in children. The Laryngoscope, 124(1): 301-305.
[4]Neu, J. & Walker, A. (2011, January 20). Necrotizing Enterocolitis. The New England Journal of Medicine, 364: 255-264.
[5]Farina, K. (2012, March 16). The Economics of Cancer Care in the United States. American Journal of Managed Care. Retrieved from www.ajmc.com/journals/evidence-based-oncology/2012/2012-2-vol18-n1/the-economics-of-cancer-care-in-the-united-states-how-much-do-we-spend-and-how-can-we-spend-it-better
[6]Zhuo, X., Zhang, P., & Hoerger, T.J. (2013, September). Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. American Journal of Preventive Medicine, 45(3): 253-61.
[7]Davis, K. (2013, April). Expenditures for Hypertension among Adults age 18 and Older, 2010: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #404, Agency for Healthcare Research and Quality. Retrieved from meps.ahrq.gov/data_files/publications/st404/stat404.shtml