Provider Handbook

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• Individual psychotherapy
• Group or conjoint therapy (up to 90 minutes)
• Crisis intervention (up to 75-80 minutes)
• Collateral visits
• Family therapy (up to 90 minutes)
• Psychoanalysis

• A provider will be allowed one psychiatric diagnostic interview examination (90801-90802 session) per beneficiary per year without authorization.
   
  
  •  If more than one 90801-90802 session is needed within the same benefit period, prior authorization must be requested using the Outpatient Treatment Report (OTR) form.
     
  •  The benefit year for TRICARE Prime, TRICARE Standard, and TRICARE Extra is based on the fiscal year (October 1–September 30).
     
• A provider cannot bill for more than two sessions per calendar week (Sunday–Saturday) without specific prior authorization.
   
• Two psychotherapy sessions may not be combined (e.g., 30 minutes on one day may not be added to 20 minutes on another day and counted as one session) to circumvent the frequency limitation criteria.
   
• When multiple sessions of the same type are conducted on the same day (e.g., two individual sessions or two group sessions), only one session is reimbursed.  Note: A collateral session may be conducted on the same day the beneficiary receives individual therapy.

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Psychological and neuropsychological testing require prior authorization for behavioral health diagnoses, regardless of the setting (inpatient or outpatient). A Preauthorization for Psychological Testing form must be submitted for prior authorizatio n.

Psychological testing must be medically necessary and performed in conjunction with otherwise-covered psychotherapy. Medical necessity must be established prior to the actual testing (i.e., there must be either a diagnosis or provisional diagnosis of a behavioral health disorder, and the testing must be appropriate for the diagnosis).

Psychological testing and assessment is generally limited to six hours in a fiscal year; however, additional hours may be approved in special circumstances.

TRICARE does not cover the following psychological and neuropsychological testing:
 

• Reitan-Indiana battery when administered to beneficiaries under age five or self-administered to beneficiaries under age 13
   
• Assessment for academic placement, including all psychological testing related to educational programs, issues, or deficiencies
   
• Testing to determine a learning disability, if the primary or sole basis for the testing is to assess for a learning disability
   
• Testing in conjunction with child custody disputes or job placement
   
• General screening (in the absence of specific symptoms of a covered behavioral health disorder) to determine if individuals being tested are suffering from a behavioral health disorder
    
• Teacher or parental referrals for psychological testing
   
• Diagnosing specific learning disorders or learning disabilities encompassing a reading disorder (e.g., dyslexia), mathematics disorder, disorder of written expression, or learning disorder not otherwise specified.

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