TRICARE has recently implemented several program and benefit changes of interest:
Autism Resources
Applied Behavioral Analysis (ABA), a treatment for autism, is now covered through the TRICARE Extended Care Health Option (ECHO) program.1 TRICARE has also launched a project to improve access to this care. The Enhanced Access to Autism Services Demonstration Project will test the feasibility and advisability of permitting TRICARE reimbursement for Educational Interventions for Autism Spectrum Disorders (EIA) services (defined as behavior modification interventions of specified characteristics) delivered by paraprofessional providers. Eligible beneficiaries include active duty family members (ADFMs) who have been diagnosed with these conditions:
Not Otherwise Specified The participant’s diagnosis must be confirmed by an Autism Spectrum Disorders (ASD) specialist. Additionally, your TRICARE patient must be at least 18 months old, enrolled in the Exceptional Family Member Program (EFMP), registered for ECHO coverage and live in the 50 United States or the District of Columbia. For more information see what Humana Military has on the
LVRS for late-stage emphysema is now a covered TRICARE benefit, but only at select facilities. LVRS must be performed at facilities that are:
For more information, visit
Centers for Medicare & Medicaid Services and
The Joint Commission.
Anesthesia for Dental Procedures
Medically necessary institutional and general anesthesia services may be covered in conjunction with non-covered or non-adjunctive dental treatment for patients with developmental, mental or physical disabilities, or for pediatric patients age 5 or under. Patients with diagnosed developmental, mental or physical disabilities are those patients with conditions that prohibit dental treatment in a safe and effective manner. The general anesthesia must be administered by a separate anesthesiology provider. Coverage of institutional services includes institutional benefits associated with both hospital and outpatient surgery settings. Prior authorization is required for above outpatient care or inpatient stays to be covered in the same manner as required for adjunctive dental care.
3D Maternity UltrasoundRendering
Three-dimensional (3D) rendering with maternity ultrasound, Current Procedural Terminology (CPT)* codes 76376 and 76377, is regarded as unproven, and is therefore, excluded from coverage. Refer to the TRICARE Policy Manual, Chapter 5, Section 2.1.
Percutaneous Vertebroplasty
CPT* codes 22520–22522, S2360, S2361 and balloon kyphoplasty (CPT* codes 22523–22525) are covered for the treatment of painful osteolytic lesions and osteoporotic compression fractures refractory to conservative medical treatment.
Provider Portal
Most transactions with Humana Military Healthcare Services, Inc. can now be completed using the secure provider portal
“MyHMHS for Providers”. By becoming a registered user of the site, you can verify eligibility; check and submit referrals, authorizations and claims; and review prescription data by patient on valid referrals.
Thank you for participating in the care of TRICARE beneficiaries!
