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Telemedicine Expanded to Include Specific Mental Health and Substance Use Disorder Treatments

Wednesday, April 29, 2020

In light of the coronavirus (COVID-19) outbreak, providers have substantially increased the use of telemedicine to minimize patient and staff exposure to the virus. In response, retroactive to March 13, 2020, the Defense Health Agency is temporarily expanding TRICARE’s telemedicine benefit to include specific mental health and substance use disorder treatments. All other conditions for coverage still apply. Find benefit details and FAQs on our Telemedicine benefits page and our COVID-19 page. 

During the coronavirus pandemic, TRICARE’s expanded telemedicine benefit will now include: 

  • Intensive outpatient program (IOP) services – IOP services for mental health or substance use disorders are generally between six and nine hours of care per week. IOPs provide therapies as clinically indicated and include case management to link beneficiaries and their families with community-based support systems. These services are subject to daily limits per TRICARE policy. Partial hospitalization program (PHP) services (six or more hours of service per day) rendered via telehealth remain not covered.
  • Opioid treatment programs (OTPs)/medication assistance treatment (MAT) – OTPs and office-based opioid treatment are covered benefits. MAT may be rendered as part of an OTP or office-based opioid treatment setting. 

TRICARE continues to cover individual psychotherapy, crisis management, family therapy, and group therapy via the telemental health benefit. 

Video conferencing platforms must meet the technical requirements outlined in TRICARE Policy Manual, Chapter 7, Section 22.1. At this time, audio-only telephone services are not covered under TRICARE.

Review telemedicine billing tips on our website. 

State license clarification
Providers delivering telemedicine services must be licensed in the state(s) in which the services are provided and received. However, during the COVID-19 pandemic, providers may render telemedicine as long as they are licensed in the state in which care is received. Temporary state licenses issued in response to COVID-19 will be accepted. Providers must practice within the scope of their licensure (including temporary licenses) and maintain copies for claims auditing purposes.