Back-to-School Physicals

 
For parents of young children, “back to school” can mean “back to the doctor’s office” for children’s annual physicals. School physicals are often required to help ensure that children enter the classroom up-to-date on immunizations, that they are in good health and free of communicable diseases. Providers should ensure patients are aware that TRICARE covers these physicals.
 
For children ages 5–11, TRICARE covers annual physicals, if required, in connection with school enrollment. Required immunizations are also covered. However, TRICARE does not cover physicals for sports or camp participation.
 
Standard office visit evaluation and management Current Procedural Terminology (CPT®) codes (99201–99205 and 99211–99214) apply. Providers should also be aware that payments for covered school physicals may not exceed what would have otherwise been reimbursed for comprehensive preventive medicine services (CPT codes 99383 and 99393).
 
Remind your active duty family member patients that TRICARE covers well-child care (eligible newborns and children up to age 6) with no copayment or cost-share. TRICARE covers well-child care for routine newborn care, comprehensive health-promotion (up to age 6) and disease-prevention exams, vision and hearing screenings, routine immunizations (in accordance with the Centers for Disease Control and Prevention guidelines) and developmental assessments (in accordance with the American Academy of Pediatrics®).