Provider Handbook
  

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Non-covered Behavioral Health Services
Sexual Disorders

Non-covered Behavioral Health Services
The following behavioral health services are not covered under TRICARE:
 
  • Aversion therapy (including electric shock and the use of chemicals for alcoholism, except for disulfiram, which is covered for the treatment of alcoholism)
  • Behavioral health services and supplies related solely to obesity and/or weight reduction
  • Bioenergetic therapy
  • Biofeedback for psychosomatic conditions
  • Carbon dioxide therapy
  • Counseling services such as nutritional counseling, stress management, marriage counseling, or lifestyle modifications
  • Custodial nursing care
  • Diagnostic admissions
  • Educational programs
  • Environmental ecological treatments
  • Experimental procedures
  • Eye movement desensitization and reprocessing training
  • Filial therapy
  • Guided imagery
  • Hemodialysis for schizophrenia
  • Intensive outpatient treatment program
  • Marathon therapy
  • Megavitamin or orthomolecular therapy
  • Narcotherapy with LSD
  • Primal therapy
  • Psychosurgery (Surgery for the relief of movement disorders, electroshock treatments, and surgery to interrupt the transmission of pain along sensory pathways are not considered psychosurgery.)
  • Rolfing
  • Sedative action electrostimulation therapy
  • Services and supplies that are not medically or psychologically necessary for the diagnosis and treatment of a covered condition
  • Sexual dysfunction therapy (see “ Sexual Disorders” later in this section)
  • Smoking cessation programs (covered only for  TPR ADSMs who meet specific criteria and through the Smoking Cessation Demonstration Program, [TRICARE Operations Manual, Chapter 20] )
  • Telephone counseling (except for geographic distant family therapy related to RTC treatment)
  • Therapy for developmental disorders such as dyslexia, developmental mathematics disorders, developmental language disorders, and developmental articulation disorders
  • Training analysis
  • Transcendental meditation
  • V codes
  • Z therapy


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Sexual Disorders
Sexual dysfunction is characterized by disturbances in sexual desire and by the psychophysiological changes that characterize the sexual response cycle causing marked distress and interpersonal difficulties. Any psychotherapy, service, or supply provided in connection with sexual dysfunction or inadequacies is excluded from TRICARE coverage. Exclusions include psychotherapy, services, or supplies for these disorders/dysfunctions:
 
  • Gender identity disorders—characterized by strong and persistent cross-gender identification accompanied by persistent discomfort with one’s assigned gender
  • Orgasmic disorders (e.g., female orgasmic disorder, male orgasmic disorder, premature ejaculation)
  • Paraphilias (e.g., exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, voyeurism, and paraphilia not otherwise specified)
  • Sexual arousal disorders (e.g., female sexual arousal disorder, male erectile disorder)
  • Sexual desire disorders (e.g., hypoactive sexual desire disorder, sexual aversion disorder)
  • Sexual dysfunction due to a general medical condition
  • Sexual dysfunctions not otherwise specified, including those with organic or psychogenic origins
  • Sexual pain disorders (e.g., dyspareunia, vaginismus)
  • Substance-induced sexual dysfunction


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Last Update: July, 2007