Coronavirus Disease (COVID-19) and TRICARE’s telemedicine benefit

April 29, 2020

**Update: Effective April 23, 2020, TRICARE has approved use of telemedicine services to include otherwise-covered behavioral health services during the COVID-19 outbreak.

These services include:

  • Telemental health services, including individual psychotherapy, crisis management, family therapy or group therapy (expected to continue after the coronavirus pandemic)
  • Medication assisted treatment (only during the coronavirus pandemic)
  • Opioid treatment programs (only during the coronavirus pandemic)
  • Intensive outpatient programs, including medication management, case management, recreational therapy, occupational therapy and discharge planning (only during the coronavirus pandemic)
  • Please note: Full-day (any services lasting six hours or longer), full-intensity PHP services provided under telemedicine are not currently covered

We are working diligently to update our claims system to reflect this change.

March 18, 2020

**Update: If a beneficiary meets all other criteria for a covered service for speech therapy and for continuation of PT/OT, (but not initiation of PT/OT), it is covered using telemedicine, using any coding modifiers as you would for a TRICARE network provider office visit.

March 17, 2020

The CDC, Department of Defense (DOD) and other government partners are closely monitoring the COVID-19 outbreak while encouraging actions to limit the spread of the virus. Utilizing the telemedicine option is a safe way to treat patients, while containing the spread to medical facilities.

TRICARE covers the use of interactive audio/video technology services, and are subject to the same referral and authorization requirements and include, but are not limited to: clinical consultations, office visits and telemental health.

As a reminder:

  • For TRICARE payment to be authorized, the provider must be TRICARE-authorized and the service must be within a provider’s scope of practice under all applicable state(s) law(s) in which services are provided and or received.
  • Video conferencing platforms used for telemedicine services must have the appropriate verification, confidentiality and security parameters necessary to meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Providers billing for telemedicine services that are:

  • Synchronous* will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Also, Place of Service “POS 02” is to be reported in conjunction with the GT modifier.
  • Asynchronous* will use CPT or HCPCS codes with a GQ modifier.

*Synchronous telemedicine services involve an interactive, electronic information exchange in at least two directions in the same time. Asynchronous telemedicine services involve storing, forwarding and transmitting medical information on telemedicine encounters in one direction at a time.

Applied Behavior Analysis (ABA) providers:

  • The TRICARE Operations Manual, Autism Care Demonstration (ACD) specifies that with the exception of completing outcome measures, the ACD does not permit for telemedicine (paragraph 8.2.2). Telemedicine is not covered for ABA services billed under CPT codes 97151, 97153, 97155 or 97156.

When submitting claims for telemedicine services, the provider may indicate "Signature not required – distance telemedicine site" in the required patient signature field. ABA providers submitting claims for outcome measures administered via telehealth must include the modifier GT.

Visit telemedicine services or TRICARE Policy Manual, Chapter 7, Section 22.1 for more information.