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Welcome TRICARE East providers

Get access to everything you need right here. You can learn how to submit electronic claims, educate yourself on reimbursements and get access to all the TRICARE resources you need.

Effective January 1, 2019, changes to CPT codes regarding the Autism Care Demonstration (ACD) were implemented. Learn more

ACD CPT code changes effective January 1, 2019

Changes include:

  • Update Category III CPT codes to Category I CPT codes
  • Clarify that new authorizations are not required for this change
  • Require use of new CPT codes for claim payment for dates of service on or after 1/1/2019
  • Confirms continued exclusion of concurrent billing of ACD
  • Clarify reimbursement rate processes for the new Category I codes
  • Clarify requirements for session notes for certain treatment plan codes

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.

Due to the changes in ACD CPT codes, DHA has authorized four additional hours (16 units) of 97155 per month per beneficiary to ensure adequate time is allowed with each beneficiary for protocol modification. You do not need to request any changes to your authorization. Please reevaluate your treatment plans for the next authorization period and request units appropriately.

There are several key changes:

  • Certain codes that were previously untimed, are now timed
  • Codes were converted from 30 minute increments to 15 minute increments
  • There is no longer a billable code for supervision. The Defense Health Agency (DHA) will rely on the supervision requirements of the credentialing bodies, but supervision is no longer being paid under the ACD
Doctor giving a flu shot to the patient

Flu season is here

Discover how TRICARE covers flu season and how beneficiaries get care. Learn more

Autism & ABA services

Learn more about TRICARE's ABA certification requirements, Humana Military credentialing requirements,
referrals and authorizations, claims requirements, forms and other ABA resources.

Learn more

Labratory Developed Tests (LDTs)

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

Cold therapy devices

Orthopedic cold therapy devices are not covered under TRICARE policy. Learn more

TRICARE urgent care changes

Urgent care can be rendered by either a TRICARE network provider or TRICARE-authorized urgent care center. Learn more

Provider self-service

Self-service for providers offers many features that will save you time,
ensure patient privacy and help manage your office more efficiently.

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