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  • New TRICARE Rule Allows for Telephone-Delivered Services, Drops Copays

    Audio-only visits will be allowed when necessary, cost-sharing is lifted, and TRICARE licensing requirements relaxed.

    In this review: TRICARE Coverage and Payment for Certain Services in Response to the COVID-19 Pandemic (interim final rule with comment period)
    Effective date: May 12, 2020

    The big picture: TRICARE is expanding the range of remote services it will allow—and is temporarily waiving copays for telehealth.
    TRICARE, the health insurance used throughout the military, will function under a new interim rule that will allow for the use of audio-only remote services for office visits "when appropriate," and eliminate copays and copayments for beneficiaries who receive services delivered via telehealth. The rule, set to go into effect May 12, also relaxes provisions around licensing requirements for providers. The new rule will remain in effect until the COVID-19 public health emergency ends.

    Important to note: The changes — especially the new provisions around the use of audio-only services — come with requirements and shouldn't be seen as blanket permissions.

    Yes, it's possible for TRICARE beneficiaries to receive care through audio-only (telephone) services, but only when appropriate — and documentation is important.
    The U.S. Department of Defense Office of the Secretary (author of the interim rule) has lifted TRICARE's prohibition on telephonic services to enable beneficiaries to have their symptoms evaluated by a provider over the phone. The change applies to any covered illness or injury, including COVID-19 symptoms, for all beneficiaries, but the services must be medically necessary and rendered by an authorized TRICARE provider within the scope of the provider's license.

    The interim rule is clear that the use of audio and visual two-way platforms is preferred, and that audio-only services should only be used when necessary — for instance, when access to broadband may be impossible. TRICARE is counting on its providers to use clinical judgment in deciding when the audio-only option is appropriate, and to carefully document their reasons for choosing the platform used.

    DoD also points out that there are circumstances under which audio-only telehealth is not appropriate — namely, any visit that requires a physical examination.

    Cost-sharing and copays for telehealth service are (temporarily) out.
    To incentivize TRICARE beneficiaries to reduce in-person visits to TRICARE providers, the rule eliminates cost-sharing, including deductibles, for all in-network authorized telehealth services. The waiver applies to TRICARE Prime and Select beneficiaries in all geographic areas but will remain only as long as the national public health emergency is in place.

    Interstate practice in TRICARE will be a little easier — and there could be international implications, too.
    For the duration of the emergency, the TRICARE system will lift its mandate that providers must be licensed in the state in which they're practicing (which could be different from the state in which they reside), even if that license isn't otherwise required. Providers still need to have an equivalent license to practice, however, and DoD acknowledges that individual states retain the authority to manage the licensing of all providers in that state's jurisdiction. The change allows TRICARE providers to make full use of relaxed interstate licensing requirements adopted by state or federal government.

    The interim rule around licensing also has implications beyond the U.S.: According to DoD, the change could also allow TRICARE providers in other countries to practice beyond that nation's borders, so long as permitted by the host nation.

    The change applies to services delivered both in person and via telehealth.


    • Are these telephone services falling under the 98966-68 CPT code series? Thank you

      Posted by Kallie Slette on 5/13/2020 5:27 PM

    • Great News! Will Tricare reimburse for initial evaluations for new patients and subsequent treatment by a PT? Thank you. Janelle

      Posted by Janelle Z Mann, PT, PCS, C/NDT on 5/14/2020 5:59 AM

    • Too bad they refuse to credential prime providers in my area for the last 8 years.

      Posted by Ron Pavkovich on 5/15/2020 6:51 PM

    • @Kallie: No. DoD is clarifying that providers could use audio-only (telephone) technology when furnishing care billed under the typical CPT codes otherwise billed when furnished via audio and visual two-way platforms (in accordance with payer policy) but only when necessary, as audio and visual two-way platforms are preferred.

      Posted by APTA staff on 5/16/2020 7:20 AM

    • @Janelle: The TRICARE contractors reimburse for telehealth services furnished by PTs, however, Humana Military has explicitly stated that it does not cover telehealth initial evaluations by PTs/OTs. APTA is continuing to advocate to Humana that it allow coverage for such services furnished via telehealth. For more information about TRICARE coverage of telehealth, please see: https://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Technology/Telehealth/Coding_and_Billing/TelehealthCOVID19FederalPayerCoverage.pdf

      Posted by APTA staff on 5/16/2020 7:20 AM

    • Does Tricare plan on reimbursing clinics for the lack of cost sharing for telehealth? And does Tricare still plan on reimbursing at the same rate as if in-clinic for the authorized CPT Codes that can be used during telehealth.

      Posted by Meredith Noll on 5/17/2020 2:15 PM

    • @Meredith: The waiving of copayments and cost-shares for in-network telehealth services will apply to all otherwise-covered services delivered via telehealth, not just those related to COVID-19, and will apply to all TRICARE beneficiaries in all geographic regions for the duration of this emergency. Please check with your TRICARE contractor regarding whether they will reimburse providers for the waived cost-sharing. And it is our understanding that TRICARE is continuing to reimburse for telehealth services at the same rate as in-person.

      Posted by APTA staff on 5/18/2020 8:35 AM

    • What CPT code, modifier and POS should we use for telephone calls? Would it be the same as when audiovisual was performed>

      Posted by Cherrie Guinto on 5/20/2020 8:37 PM

    • @Cherrie: Yes, that is our understanding at this time, however DoD will provide additional parameters and policy regarding audio-only telehealth encounters in the implementing instructions consistent with this Interim Final Rule and other provisions of TRICARE policy. Please also note that DoD states the following regarding use of telephone services in the Interim Final Rule: “The use of audio-only telehealth should be for the purpose of providing assessment, diagnosis, clinical care, or formal patient education from an authorized provider to a patient, or for providing clinical consultation between providers that directly impacts upon a particular patient’s care. The authorized provider should determine that a phone call is appropriate for accomplishing the clinical goals of the encounter and document appropriately. If the decision to provide care via a traditional audio/visual method is chosen, the reasons for that decision should be documented as well. For recurring care, the rationale for choosing audio-only or audio and visual should be documented only at the initiation of remote care, or upon any change in modality. Care that normally requires a physical examination (including a remote physical examination requiring a tele-presenter such as a nurse) is not appropriate for audio-only telehealth encounters.

      Posted by APTA Staff on 5/21/2020 8:13 AM

    • Will Tricare allow a hospital's outpatient provider based practice to bill the originating site fee (Q3014) for covered Telehealth visits when the patient is in their home.

      Posted by Margaret Hartsgrove on 5/26/2020 1:15 PM

    • @Margaret: Please check with your TRICARE contractor to determine if they are following Medicare’s flexibilities for hospitals as discussed on page 1 of this fact sheet: https://www.cms.gov/files/document/covid-hospitals.pdf

      Posted by APTA staff on 5/27/2020 8:08 AM

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