Beneficiaries with current authorizations for CPT code 97156 (Patient/Caregiver Guidance) can no longer receive unlimited telemedicine visits. Additional telemedicine visits for parent training will require prior approval.
Beneficiaries who enter the Autism Care Demonstration (ACD) after August 1, 2021 cannot be administered care via telemedicine for CPT code 97156 (Patient/Caregiver Guidance) until after the first six months of the authorization period.
Providers should be aware that the TRICARE Operations Manual (TOM) Chapter 18 Section 4 for ACD claims reimbursement will be followed.
For more information on autism and the most recent updates on changes to the ACD, visit Comprehensive Changes to the Autism Care Demonstration