Bread Crumbs

Substance Use Disorder Treatment

Covered by TRICARE?Limits
Yes Coverage includes detoxification, rehabilitation, outpatient group and family therapy. Must have prior authorization

TRICARE may cover services for the treatment of substance use disorders when determined to be medically or psychologically necessary, including:

  • Detoxification
  • Rehabilitation
  • Outpatient group therapy
  • Family therapy

TRICARE covers:

Detoxification

  • Inpatient stays are limited to seven days
    • Must be an approved substance use disorder facility
    • Limit can be waived by your regional contractor
    • Care must be provided under general medical supervision
  • Counts toward the 30- or 45-day limit for acute inpatient psychiatric care
  • Emergency and inpatient hospital services are covered for medical stabilization and treatment of medical complications of substance use disorder.
    • Prior authorization isn't required in the case of an emergency, but you must get authorization for continued services.
    • If admitted, contact your regional contractor within 72 hours of the admission for authorization.
    • Emergency and inpatient hospital services are considered medically necessary only when the patient’s condition is such that the personnel and facilities of a hospital are required.

Rehabilitation

Rehabilitation may occur in an inpatient or partial hospitalization setting.

  • Must be in a TRICARE-authorized facility
  • 21 days or one inpatient stay per benefit period is covered
  • Counts toward the 30- or 45-day limit of acute inpatient psychiatric care

Outpatient Group Therapy

TRICARE covers 60 group therapy sessions per benefit period.

  • Must be provided by an approved substance use disorder facility in a group setting.
  • Individual outpatient therapy isn't covered.
  • These 60 sessions are in addition to the 15 covered family therapy visits

Family Therapy

TRICARE covers 15 outpatient family therapy visits per benefit period.

  • Family therapy begins after rehabilitation. 
  • Individual outpatient therapy isn't covered.
Disclaimer:

This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 10/9/2014