Providers delivering virtual health services must be licensed in the state(s) where the services are provided and received. Video conferencing platforms used for virtual health services must have the appropriate verification, confidentiality and security parameters necessary to meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
Beginning July 1, 2022, cost-shares and copayments will no longer be waived.
Referrals are required for Active Duty Service Members (ADSM)
Beneficiaries participating in the Autism Care Demonstration (ACD) with current authorizations for parent training can no longer receive unlimited virtual health visits - additional virtual health visits for parent training will require prior approval.
TRICARE covers the use of interactive audio/video technology to provide clinical consultations and office visits when appropriate and medically necessary. These services are subject to the same referral and authorization requirements and include, but are not limited to:
Billing information
Place of Service (POS)
POS refers to where a beneficiary is located for a virtual health encounter when receiving care. This is known as the origination site. The provider’s location at the time of service is known as the distant site.
What determines the POS code?
The POS code is dictated by the beneficiary’s location, or origination site, when the service is rendered.
For example:
Synchronous virtual health services
These services involve an interactive, electronic information exchange in at least two directions in the same time period. Providers billing for synchronous virtual health services will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish virtual health services.
Asynchronous virtual health services
These services involve storing, forwarding and transmitting medical information on virtual health encounters in one direction at a time. Providers billing for asynchronous virtual health services will use CPT or HCPCS codes with a GQ modifier.
When submitting claims for virtual health services, the provider may indicate "Signature not required – distance virtual health site" in the required patient signature field.
See more on virtual health services from TRICARE Policy Manual (TPM), Ch. 27, Sec. 1 and the TRICARE provider handbook.
Available platforms
As healthcare evolves, Humana Military is identifying and utilizing different and innovative ways to help providers deliver simple and effective care. Working closely with outside platforms, we are providing new and discounted options in virtual health services.
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