Updated Autism Care Demonstration (ACD) concurrent billing information

December 13, 2021

Per TRICARE policy, concurrent billing is not permitted. Only one code should be billed when concurrent care services are performed. If both are billed concurrently TRICARE will pay the higher charge and deny the lesser. If the lesser charge is received first, TRICARE will pro-rate the higher charge.

Note: When billing any session, please remember to enter the appropriate units rendered for the applicable procedure code.

For additional guidance see the TRICARE Operations Manual, Chapter 18, section 3,

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. Documentation must indicate two separate rendering providers and locations for the services.

  • The contractor shall pay the higher rate and deny the other if CPT codes 97153 and 97155 are billed concurrently.

  • CPT CODES 97151 97153 97155 97156 97157 97158
    97151 N/A
    97153 Y N/A
    97155 N N N/A
    97156 Y Y Y N/A
    97157 Y Y Y N N/A
    97158 Y N N Y Y N/A