TRICARE FAQs: COVID-19 and Telemedicine Services
As you begin to schedule a doctor’s appointment, you may have questions about your TRICARE benefit. You can find answers to your frequently asked questions (FAQs) and more on the TRICARE Coronavirus FAQs page.
The following are some of the most frequently asked questions about telemedicine or telehealth and COVID-19:
Question: What type of telehealth or telemedicine services does TRICARE cover?
Answer: TRICARE covers many telehealth and telemedicine services from a military provider or TRICARE-authorized provider. Your care must be medically or psychologically necessary. And the care must be appropriate. Covered services may include:
- Primary, routine, and specialty care
- Behavioral health care, like psychotherapy, or family guidance or training from a board certified behavior analyst under the Autism Care Demonstration
- Physical therapy or occupational therapy
The Defense Health Agency (DHA) recently introduced three temporary changes to improve virtual access to health care during COVID-19. With the policy changes:
- TRICARE will temporarily pay for certain phone (audio-only) telehealth services. Your visit must be medically or psychologically necessary. It must be appropriate as well. This means you may have a phone visit with your provider to evaluate and manage your care. This could also be a psychotherapy visit. TRICARE won’t pay for all phone visits. Some visits are more appropriate face-to-face or through audio-video channels.
TRICARE billing and payment rules still apply. Also, your TRICARE program and plan rules still apply. This means if you have TRICARE Prime, you’ll still need to get a primary care manager (PCM) referral for specialty care. For information on how to get care with your health plan, check out the TRICARE Choices in the United States Handbook. If you have an overseas health plan, refer to the TRICARE Overseas Program Handbook.
- TRICARE is temporarily paying providers who practice across state or country lines. This only applies when federal, state, or host nation laws allow the out-of-state or international practice. This helps in areas where there is a high-need for health care services.
This change includes both in-person and telemedicine services. Your provider can’t be barred or restricted from practice in any state. He or she can’t be on the Department of Health and Human Services sanction list either. If you live stateside, your provider’s license must permit his or her practice out-of-state. If you’re in an overseas area, your provider’s host-nation must permit inter-country practice. This means your provider must be licensed in both countries.
- TRICARE is temporarily waiving your copayments or cost-shares for telehealth services you get. This includes your deductible (if applicable). Keep in mind that this applies to TRICARE covered services you get from in-network providers. It’s not just for your COVID-19 care. Both TRICARE Prime and TRICARE Select enrollees are eligible.
These temporary changes went into effect on May 12 in the U.S. and will be in place until the end of the president’s declared national emergency. Starting March 10, the changes went into effect overseas. In overseas areas, they may be in place beyond the U.S. national emergency date. Be sure to reach out to your regional contractor if you have questions.
Question: I have TRICARE and live overseas. Many providers aren’t seeing patients in their offices. Does TRICARE cover telehealth and telemedicine here due to COVID-19?
Answer: TRICARE may cover certain telemedicine overseas. These services must be medically or psychologically necessary, as well as appropriate. If you’re seeing a civilian TRICARE Overseas Program (TOP) network or participating provider, they must:
- Follow host nation country privacy laws
- Meet telemedicine credentialing requirements
- Follow TRICARE policy requirements
Keep in mind that you’ll still have to get referrals or authorizations for your telemedicine or telehealth services if you have TOP Prime. Your PCM has to submit a “Defer to Network Request (DTNR)” to your overseas contractor. The DTNR has to note your need for telemedicine services. Do you have TOP Prime Remote? If so, you’ll need to call your TOP Regional Call Center for all of your telemedicine services. This includes your first visit. It also includes follow-up visits that you may need.
Do you plan to self-refer for services you need? If so, you’ll need to see a telemedicine credentialed provider. This applies if you choose to self-refer for some outpatient mental health services. If you’re active duty service member, you have to get pre-authorization for all types of mental care you seek. This will come from your PCM at your military hospital or clinic, or from your overseas contractor.
Services that TRICARE doesn’t now cover under the TOP aren’t covered through telemedicine. Be sure to contact your TOP Regional Call Center if you have questions. You can also go to the Medical Care FAQ topic to learn more.
Question: Does TRICARE cover telehealth services for the Intensive Outpatient Program? IOP is often the last stop before hospitalization.
Answer: Did you know that DHA updated its telemental health guidance to include intensive outpatient programs (IOPs)? TRICARE may cover certain diagnostic and treatment services you receive through telehealth. These services must be medically or psychologically necessary, as well as appropriate. Not sure if your service is necessary or appropriate? You can visit the Medical Care FAQ topic to read the definitions.
An IOP takes place in an organized setting either during the day or in the evening. It can be anywhere between 2 and 6 hours long. Your provider may carry out some of these IOP services via telehealth. Some examples include:
- Individual psychoeducation
- Case management
- Recreational therapy
You’ll need to get a referral or pre-authorization for IOP care. You can contact your regional contractor if you have questions. And you can go to the Medical Care FAQ or Covered Services page to learn more about IOPs and other outpatient behavioral health telehealth services that TRICARE may cover.
“Telemedicine has become an important tool in caring for patients while keeping providers and others safe during the COVID-19 pandemic,” said Christopher Priest, deputy assistant director, Health Care Operations, Defense Health Agency. “These changes will help TRICARE beneficiaries by making it easier for you to use telehealth services for your health care needs.”
For more on COVID-19 FAQs, you can check out ones on face masks, children, and resuming elective procedures. As you continue to ask important questions, TRICARE is committed to getting you answers. Learn more about telemedicine services that TRICARE covers to help you get the care you need from a distance. Stay safe, and stay informed.
Last Updated 6/23/2020