Behavioral Health Care Services Coverage Details
|
Figure 3.5 provides coverage details for outpatient behavioral health care services. Note: This chart is not all-inclusive.
Figure 3.5 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
- Psychoanalysis
|
| 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 (October 1 - September 30) (Testing 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
- Diagnosed specific learning disorders or learning disabilities
|
| 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.
|
Figure 3.6 provides coverage details for inpatient behavioral health care services. Note: This chart is not all-inclusive.
Figure 3.6 Behavioral Health Care Services: Inpatient Coverage Details
| Service |
Description |
| Acute Inpatient Psychiatric Care
|
May be covered on an emergency or nonemergency basis. Prior authorization from Humana Military is required for all nonemergency inpatient admissions. In emergency situations, authorization is required for continued stay.
Limitations:
- Patients age 19 and older: 30 days per fiscal year (FY)1 or in any single admission
- Patients age 18 and under: 45 days per FY1 or in any single admission
- Inpatient admissions for substance use disorder detoxification and rehabilitation count toward the 30- or 45-day limit
Note: Stay limits may be waived if determined to be medically or psychologically necessary.
|
| Partial Hospitalization Program (PHP) |
Psychiatric PHPs provide interdisciplinary therapeutic services at least three hours a day, five days a week, in any combination of day, evening, night, and weekend treatment programs. The following rules apply:
- Prior authorization from Humana Military is required. PHP admissions are not considered emergencies.
- Facilities must be TRICARE-authorized.
- PHPs must agree to participate in TRICARE.
Limitations:
PHP care is limited to 60 treatment days (whether full- or partial-day treatment) per FY1 or for a single admission. These 60 days are not offset by or counted toward the 30- or 45-day inpatient limit.
|
| Residential Treatment Center (RTC) Care |
RTC care provides extended care for children and adolescents with psychological disorders that require continued treatment in a therapeutic environment. The following rules apply:
- Facilities must be TRICARE-authorized.
- Unless therapeutically contraindicated, the family and/or guardian should actively participate in the continuing care of the patient through either direct involvement at the facility or geographically distant family therapy.
- Prior authorization from Humana Military is required. RTC admissions are not considered emergencies.
- RTC care is considered elective and will not be covered for emergencies.
- Admission primarily for substance use rehabilitation is not authorized.
- Care must be recommended and directed by a psychiatrist or clinical psychologist.
Limitations:
- Care is limited to 150 days per FY1 or for a single admission. (Limitations may be waived if determined to be medically or psychologically necessary.)
- RTC care is only covered for patients age 21 or younger.
|
1 October 1 - September 30
Back to Top |
