BREAKING: COVID-19 Guidance for Tricare members and Providers

Dear Providers,

TRICARE’s benefit and billing requirements are provided regarding the use of Telemedicine in response to COVID-19.  As of the most recent update on March 13, 2020 the following information is listed on the Tricare-West website:

TRICARE covers medically and psychologically necessary telemedicine services provided to a beneficiary at home. Specific technical requirements, outlined in TRICARE Policy Manual, Chapter 7, Section 22.1, must be met. (Note: The telemedicine exclusions for applied behavior analysis services, outlined in the TRICARE Operations Manual, Chapter 18, Section 4, paragraph 19.0, remain in effect.)

How does state licensing apply to telemedicine?
Providers delivering telemedicine services must be licensed in the state(s) in which the services are provided and received. (For example, if the beneficiary’s home is in California but the provider is located in Washington, that provider must be licensed in California and Washington for the services to be covered by TRICARE.)

Is an authorization required?
Telemedicine services are subject to the same authorization and referral requirements that apply to in-person medical and psychological services. Visit our Prior Authorization, Referral and Benefit Tool to view current approval guidelines.

What video conference platforms can be used?
Video conferencing platforms must meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Find additional details on video conferencing, connectivity and privacy guidelines on our Telemedicine Services page.

What is the difference between synchronous and asynchronous telemedicine services?
Synchronous telemedicine services refers to the exchange of electronic information in at least two directions at the same time, such as real-time video. Asynchronous telemedicine services refers to storing/transmitting information in one direction at a time, such as submitting medical history or images from one party to another.

How does billing work?
For synchronous telemedicine services, bill using CPT or HCPCS codes with a GT modifier for the distant site and Q3014 for the originating site to distinguish telemedicine services. Use place of service “02” in conjunction with the GT modifier. For asynchronous telemedicine services, bill using CPT or HCPCS codes with a GQ modifier and place of service “02.” Note: You may indicate "Signature not required – distance telemedicine site" in the required patient signature field on the claim form.



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