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CPT code changes
Effective January 1, 2019, changes to CPT codes regarding the Autism Care Demonstration (ACD) were implemented. Learn more
The ACD adopted the new Category I CPT codes that directly transferred from the Category III codes. Specifically, the ACD has adopted 97151, 97153, 97155 and 97156. Providers should use the approved new codes for all services provided on or after January 1, 2019.
There are several key changes:
*For guidance on the appeals process, refer to the TRICARE claims information section of the provider handbook.
Concurrent billing is excluded for all ACD Category I CPT codes except when the family and the beneficiary are receiving separate services and the beneficiary is not present in the family session. For example, CPT 97153 and 97156 could be billed concurrently if services were being provided to the beneficiary and family in two separate locations. Documentation must indicate two separate rendering providers and locations for the services. If CPT 97153 and 97155 are billed concurrently, the higher rate will be paid and the other will be denied.
Prior authorization is required for laboratory developed tests except for Cystic Fibrosis (CF) testing. Claims for genetic testing submitted without an approved authorization will be denied. Find out more
Orthopedic cold therapy devices are not covered under TRICARE policy. Learn more
Urgent care can be rendered by either a TRICARE network provider or TRICARE-authorized urgent care center. Learn more
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