Provider Handbook

  

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Behavioral Health Care Partial Hospitalization Programs:
Coverage Details

Fig. 6.6

All Partial Hospitalization Services
  • All services require medical necessity review and prior authorization.
  • Minimum of three hours therapeutic services, up to five days per week
Behavioral Health Disorder
  • Benefits are limited to 60 treatment days per fiscal year.
  • The 60 treatment days are not offset by or counted toward the 30- or 45-day inpatient limit.
  • Care must be provided in a TRICARE-authorized mental health partial hospitalization program.   
Substance Use Disorder
  • Benefits are limited to 21 treatment days (full day or partial day) per benefit period (combined partial and/or residential).
  • Benefit period starts the first day of covered treatment and ends 365 days later.
  • Days count toward the 60-day psychiatric partial hospitalization limit.


 

 

 

 

 

 




 


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Last Update: July, 2007