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What TRICARE Providers Need to Know
TRICARE covers behavioral health care (listed below) that is considered medically necessary. Although TRICARE Prime beneficiaries are highly encouraged to coordinate all health care with their primary care manager (PCM), they and TRICARE Standard beneficiaries are eligible to receive the first eight outpatient behavioral health visits each fiscal year without a referral from a PCM or authorization.
All appointments after the first eight require authorization. For outpatient services, behavioral health providers must submit a request by fax to 1-904-363-1504 or by mail to the following address:
ValueOptions
P.O. Box 551188
Jacksonville, FL 32255-1188
No additional sessions are authorized until the treatment request is reviewed.
For more information on behavioral health services, providers can contact Humana Military through the provider service line at 1-800-444-5445.
TRICARE Covers...
- Outpatient psychotherapy
- Medication management
- Acute inpatient psychiatric care
- Partial hospitalization programs
- Residential treatment center care
- Care for substance use disorders
TRICARE Does Not Cover*...
- Smoking cessation programs
- Weight loss counseling
- Custodial nursing care
- Psychotherapy for developmental disorders
* For the complete list of non-covered, you can refer to the Behavioral Health Services section of your TRICARE Provider Handbook or contact your Humana Military Provider Relations representative.
Authorized Providers Include...
- Psychiatrists
- Clinical psychologists
- Certified psychiatric nurse specialists
- Clinical social workers
- Certified marriage and family therapists
- Pastoral counselors—with physician referral and supervision
- Mental health counselors—with physician referral and supervision
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