• Individual psychotherapy (session not to exceed 60 minutes but may extend to 120 minutes for crisis intervention)
• Family or conjoint psychotherapy (session not to exceed 90 minutes but may extend to 180 minutes for crisis intervention)
• Group psychotherapy (session not to exceed 90 minutes)
• Crisis intervention (individual psychotherapy session not to exceed 120 minutes; family or conjoint psychotherapy session not to exceed 180 minutes)
• Collateral visits
• Psychoanalysis

Outpatient psychotherapy is limited to a maximum of two psychotherapy sessions per week in any combination of individual, family, collateral, or group sessions. The following frequency limitations apply to outpatient psychotherapy:

• A provider will be allowed one psychiatric diagnostic exam (CPT code 90801) or one interactive diagnostic exam (CPT code 90802) per beneficiary per year without authorization.
• If more than one CPT code 90801 or 90802 session is needed within the same benefit period, prior authorization must be requested using the TRICARE Outpatient Treatment Report (OTR) form.
• The benefit year for TRICARE program option beneficiaries (e.g., TRICARE Prime, TRICARE Standard, TRICARE Extra, TRS) 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 to circumvent the frequency limitation criteria (e.g., 30 minutes on one day may not be added to 20 minutes on another day and counted as one session).
• 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.
• Crisis intervention always requires authorization; request as soon as possible after services are rendered.

Specific prior authorization will be required for any services requested above the frequency limitations.
         

Psychological and Neuropsychological Testing

Psychological testing and assessment is generally approved up to six hours in a fiscal year. However, additional hours may be approved in special circumstances by submitting a request to ValueOptions.

TRICARE does not cover the following psychological and neuropsychological testing:

• Reitan-Indiana battery test when administered to beneficiaries under age 5 or when 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 the individual being tested is 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

Medication Management

Medication management is covered when provided as an independent procedure and rendered by a TRICARE-authorized provider practicing within the scope of his or her license. Medication management does not require prior authorization.

When a provider is performing medication management along with therapy, prior authorization is required after the initial eight unmanaged sessions.
         

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is covered when determined to be medically necessary.

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