July 17, 2020

The Defense Health Agency (DHA) has issued new guidance on the use of telemedicine for TRICARE-covered diagnostic and treatment services. Services must be medically or psychologically necessary and appropriate.

IOP guidelines

• Two to less than six-hour outpatient program taking place in an organized setting, day or evening.
• Providers may carry out some IOP services via telemedicine (for example, individual psychoeducation, case management, recreational therapy, etc.). Telemedicine does not cover: drug screening, group psychotherapy and some other services.
• TRICARE policy requires a referral OR prior authorization for IOP care.
• The IOP or half-day PHP providing services by telemedicine must be at the same intensity and level of service required by those programs per policy. The provider must show they are offering all components of the IOP via telemedicine (e.g., at least two hours of services). IOPs and half-day PHPs must document all services via telemedicine in the medical records and on the claim.

Please note: Full-day (any services lasting six hours or longer), full-intensity PHP services provided under telemedicine are not currently covered.

Billing guidelines

Providers should hold their claims until after August 10, 2020. After August 10, please submit claims using the modifier GT and revenue code 0780.

See the TRICARE Policy Manual, Chapter 7, Section 22.1 for more information.