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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.

Do you need to request a 1099?

Contact us at (800) 351-9915. If you need to update your address you can fill out a W-9 form and fax it to us at: (608) 221-7535.

CPT code changes

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

ACD billing updates

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.

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

ACD CPT code modifications made April 15, 2019

Changes include:

  • CPT 97151 must be used within 14 calendar days of the first date of service for CPT 97151, and is a use-or-lose concept
  • If CPT 97151 is billed with a date of service outside 14 calendar days of the first date of service, the claim will be denied
  • An exception to the 14-day rule can be granted in situations out of the provider’s control
  • If the delay was the result of circumstances outside of the provider's control, the provider may follow the appeals process for exception consideration

    *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.

Learn more

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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You can find the handbook, charts, newsletters, presentations, forms and more.

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