Outpatient Behavioral Health Care Services
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Referrals and authorizations may apply for certain outpatient services. ADSMs should always seek nonemergency behavioral health care at military treatment facilities (MTFs), when available. If services are not available, ADSMs must obtain referrals from their MTFs or service points of contact before receiving civilian care for each visit outside an MTF. All other TRICARE beneficiaries (non-ADSMs) do not need PCM referrals or prior authorization from their regional contractors for the first eight outpatient behavioral health care visits per FY (October 1–September 30) to a network provider authorized under TRICARE regulations to see patients independently for a medically diagnosed and covered condition.
Note: This figure is not all-inclusive. Behavioral Health Care Services: Outpatient Coverage Details
| Service |
Description |
Outpatient Psychotherapy
(physician referral and supervision required when seeing licensed or certified mental health counselors and pastoral counselors) |
The following outpatient psychotherapy limits apply:
- Psychotherapy: Two sessions per week in any combination of the following types:
- Individual (adult or child): 60 minutes per session; may extend to 120 minutes for crisis intervention
- Family or conjoint: 90 minutes per session; may extend to 180 minutes for crisis intervention
- Group: 90 minutes per session
- Collateral visits: Up to 60 minutes per visit (Collateral visits are counted as individual psychotherapy sessions. Beneficiaries have the option of combining collateral visits with other individual or group psychotherapy visits.)
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| Psychoanalysis |
Psychoanalysis differs from psychotherapy and requires prior authorization. After prior authorization is obtained, treatment must be given by approved providers. |
| Psychological Testing and Assessment |
Testing and assessment is covered when medically or psychologically necessary and provided in conjunction with otherwise-covered psychotherapy. Psychological tests are considered to be diagnostic services and are not counted toward the limit of two psychotherapy visits per week.
Limitations:
Testing and assessment is generally limited to six hours per fiscal year (FY).1 Any testing beyond six hours requires a review for medical necessity.
Exclusions:
Psychological testing is not covered for the following circumstances:
- Academic placement
- Job placement
- Child-custody disputes
- General screening in the absence of specific symptoms
- Teacher or parental referrals
- Testing to determine whether a beneficiary has a learning disability
- Diagnosed, specific learning disorders or learning disabilities
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| Medication Management |
If you are taking prescription medications for a behavioral health condition, you must be under the care of a provider who is authorized to prescribe those medications. Your provider will manage the dosage and duration of your prescription to ensure you are receiving the best care possible. Medication-management appointments are medical appointments and do not count against the first eight outpatient behavioral health care visits per FY.1 |
1 October 1–September 30.
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