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Is It Covered?

Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.

Substance Use Disorder Treatment

A substance use disorder includes alcohol or drug abuse or dependence. TRICARE may cover services for the treatment of substance use disorders, including detoxification, rehabilitation, and outpatient group and family therapy.

Detoxification

TRICARE covers three substance use disorder treatment benefit periods in a lifetime (waiver possible in accordance with policy criteria). A benefit period begins with the first date of covered treatment and ends 365 days later, regardless of the total services used during that period.

  • Emergency and inpatient hospital services for detoxification, stabilization and for treatment of medical complications of substance use disorders do not count for purposes of establishing the beginning of a benefit period.
  • 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.
  • All treatment for substance use disorders requires prior authorization from your regional contractor.

Rehabilitation

Rehabilitation of a substance use disorder may occur in an inpatient or partial hospitalization setting. TRICARE covers 21 days or one inpatient stay per benefit period in a TRICARE-authorized facility.

  • Prior authorization from your regional contractor is required.
  • Counts toward the 30- or 45-day limit of acute inpatient psychiatric care.
  • Benefit period begins with the first day of covered treatment and ends 365 days later, regardless of the total services used during that time.

Outpatient Group Therapy

Outpatient therapy for substance use disorders must be provided by an approved substance use disorder facility in a group setting. TRICARE covers 60 group therapy sessions per benefit period. Individual outpatient therapy is not covered for substance use disorders.

  • Prior authorization from your regional contractor is required.
  • Benefit period begins with the first day of covered treatment and ends 365 days later, regardless of the total services used during that time.
  • These 60 sessions are in addition to the 15 sessions of family therapy that TRICARE covers.

Family Therapy

Outpatient family therapy is covered beginning with the completion of rehabilitative care. TRICARE covers 15 visits per benefit period. Individual outpatient therapy is not covered for substance use disorders.

  • Prior authorization from your regional contractor is required.
  • Benefit period begins with the first day of covered treatment and ends 365 days later, regardless of the total services used during that time.
Disclaimer:

This A-Z list of topics is not all inclusive. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all.

Last Updated 9/2/2014