Prenatal care is important, and we strongly recommend that those who are pregnant or who anticipate becoming pregnant seek appropriate medical care. TRICARE Standard and TRICARE Extra cover all necessary maternity care, from your first obstetric visit through six weeks after your child is born. Covered services include:
- Obstetric visits throughout your pregnancy
- Medically necessary fetal ultrasounds
- Hospitalization for labor, delivery, and postpartum care
- Anesthesia for pain management during labor and delivery
- Medically necessary cesarean sections
- Management of high-risk or complicated pregnancies
Newborns are covered separately. To ensure your newborn is covered by TRICARE, see “Having a Baby or Adopting a Child” in the Changes to Your TRICARE Coverage section.
The following services are not covered by TRICARE:
- Fetal ultrasounds that are not medically necessary (e.g., to determine your baby’s sex), including three- and four-dimensional ultrasounds
- Services and supplies related to noncoital reproductive procedures (e.g., artificial insemination)
- Management of uterine contractions with drugs that are not FDA-approved for that use (i.e., off-label use)
- Home uterine activity monitoring and related services
- Unproven procedures (e.g., lymphocyte or paternal leukocyte immunotherapy for the treatment of recurrent miscarriages, salivary estriol test for preterm labor)
- Umbilical cord blood collection and storage, except when stem cells are collected for subsequent use in the treatment of tumor, blood, or lymphoid disease
- Private hospital rooms (TRICARE generally does not cover private rooms; however, some MTFs may have private postpartum rooms.)
Maternity Ultrasounds
TRICARE covers medically necessary maternity ultrasounds, including those needed to:
- Estimate gestational age due to unknown date of last menstrual period, irregular periods, size/date difference of greater than two weeks, or pregnancy while on oral contraceptive pills (Confirmation of estimated gestational age is not a medically necessary indication.)
- Evaluate fetal growth when the fundal height growth is significantly greater than expected (more than 1 cm per week) or less than expected (less than 1 cm per week)
- Conduct a biophysical evaluation for fetal wellbeing when the mother has certain conditions (e.g., insulin-dependent diabetes mellitus, hypertension, systemic lupus, congenital heart disease, renal disease, hyperthyroidism, prior pregnancy with unexplained fetal demise, multiple gestations, post-term pregnancy after 41 weeks, intrauterine growth retardation, oligoor polyhydramnios, preeclampsia, decreased fetal movement, isoimmunization)
- Evaluate a suspected ectopic pregnancy
- Determine the cause of vaginal bleeding
- Diagnose or evaluate multiple births
- Confirm cardiac activity (e.g., when fetal heart rate is not detectable by Doppler, suspected fetal demise)
- Evaluate maternal pelvic masses or uterine abnormalities
- Evaluate suspected hydatidiform mole
- Evaluate fetus condition in late registrants for prenatal care
A physician is not obligated to perform ultrasonography on a patient who is at low risk and has no medical indications.
Some providers offer patients routine ultrasound screening as part of the scope of care after 16–20 weeks of gestation. TRICARE does not cover routine ultrasound screening. TRICARE only covers maternity ultrasounds with valid medical indication that constitutes medical necessity. Refer to TRICARE's web site for additional details on maternity ultrasound coverage. |
