• Non-ADSMs may self-refer for the first eight outpatient behavioral health care visits to network providers for covered benefits per FY. Visits beyond the initial eight self-referred visits require prior authorization from ValueOptions.
• ADSMs must have PCM referrals and prior authorizations, or SPOC referrals and authorizations if enrolled in TPR, to obtain civilian care. Prior authorization may also be required.
• Physician referral and supervision are required for any visit to a licensed or certified mental health or pastoral counselor. See “Referral and Authorization Requirements” earlier in this section for details.

Outpatient Psychotherapy

TRICARE covers medically necessary outpatient psychotherapy used to treat covered behavioral health components of an otherwise diagnosed medical or psychological condition. Services must be rendered by qualified, TRICARE-authorized behavioral health care providers practicing within the scopes of their licenses to eligible TRICARE beneficiaries who have met any applicable requirements for a referral/authorization.

The following rules apply:

• A provider cannot bill for more than two sessions per calendar week (Sunday–Saturday) without prior authorization from ValueOptions.
• 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.
• Two psychotherapy sessions may not be combined to circumvent limits (e.g., 30 minutes on one day may not be added to 20 minutes on another day and counted as one session).

The following outpatient psychotherapy coverage limits apply:

• Psychotherapy: two sessions per week, in any combination of the following types:
  • Individual (adult or child): 60 minutes per session; may extend to 120 minutes for crisis intervention
  • Family or conjoint: 90 minutes per session; may extend to 180 minutes for crisis intervention
  • Group: 90 minutes per session
• Collateral visits
• Psychoanalysis

For more information about outpatient psychotherapy, refer to the TRICARE Policy Manual, Chapter 7, Section 3.13 at TRICARE Manuals Online.
     

Psychological Testing and Assessment

TRICARE covers medically necessary testing and assessment when provided in conjunction with otherwise-covered psychotherapy. Psychological tests are covered as diagnostic services and do not count toward the limit of two psychotherapy visits per week. Referrals and prior authorizations are not required when the rules outlined below are met.

Psychological testing is generally limited to six hours per year. ValueOptions may approve additional hours on a case-by-case basis. Visit the “MyHMHS for Providers” portal to request prior authorization from ValueOptions.

Psychological testing is not covered for the following circumstances:

• Academic placement
• Job placement
• Child-custody disputes
• General screening in the absence of specific symptoms
• Teacher and parental referrals
• Diagnosed specific learning disorders or learning disabilities
• For the Reitan-Indiana battery when administered to a patient under age 5 and for self-administered tests to a patient under age 13

For more information about psychological testing and assessment, refer to the TRICARE Policy Manual, Chapter 7, Section 3.12 at TRICARE Manuals Online.
    

Medication Management

TRICARE covers medication management provided as an independent procedure when rendered by a provider who is authorized to prescribe the medication. Medication management does not require prior authorization from ValueOptions. However, prior authorization is required for medication management provided with therapy, except for the non-ADSM patient’s initial eight self-referred outpatient behavioral health care visits per FY.

For more information about medication management, refer to the TRICARE Policy Manual, Chapter 7, Section 3.15 at TRICARE Manuals Online. 
      

Electroconvulsive Therapy

TRICARE may cover medically necessary electroconvulsive treatment rendered by a qualified provider. However, using electric shock as negative reinforcement (aversion therapy) is not covered.
      

Telemental Health Program

The Telemental Health program uses secure, two-way audio-visual conferencing to connect stateside TRICARE beneficiaries with off-site TRICARE network providers. Telemental Health provides medically necessary behavioral health care services, including:

• Clinical consultation
• Individual psychotherapy
• Psychiatric, diagnostic interview examination
• Medication management

Telemental Health interaction may involve live, two-way audio-visual visits between patients and medical professionals. Beneficiaries can access Telemental Health services at TRICARE-authorized Telemental Health-participating facilities by using a telecommunications system to contact TRICARE network providers at remote locations. Services rendered from a beneficiary’s home are not covered by TRICARE.

Behavioral health care limitations, authorization requirements, deductibles, and cost-shares apply. For more information, visit the TRICARE Mental Health and Behavioral web page.

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