TRICARE reimburses for Applied Behavior Analysis (ABA) services to eligible beneficiaries diagnosed with Autism Spectrum Disorder (ASD). For Autism Care Demonstration (ACD) eligibility, the covered diagnosis is F84.0. It is important to note this diagnosis should be the primary diagnosis on an ABA claim.
See TRICARE Operations Manual (TOM) Ch.18, Sec 4, 11.12
11.12 Autism Spectrum Disorder (ASD)
For ACD eligibility, the covered diagnosis is ASD (F84.0) according to the DSM-5/Autistic Disorder according to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The ASD diagnosis must specify the level of support according to the DSM-5 criteria (Level 1 = mild, Level 2 = moderate, or Level 3 = severe).
