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The Managed Care Support (MCS) Manuals (T-3) for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each T-17 manuals' web page.

TRICARE Policy Manual 6010.57-M

Each TRICARE Manual posted on the website incorporates all published changes. Although changes are published, they are not implemented by the contractors until they receive direction to do so by the Contracting Officer. Each TRICARE Manual on the web incorporates all changes by the date of publication. Although changes are published, they may not be implemented by the contractor until directed to do so by the Contracting Officer.
The TRICARE Policy Manual (TPM) is incorporated by reference in the Managed Care Support Contracts (MCSCs) and is the primary vehicle for policy and benefit guidelines and instructions. The TPM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TPM, in conjunction with the April 2015 TRICARE Reimbursement Manual (TRM), provides guidance, policy interpretations and decisions implementing TRICARE, including those policies and procedures applicable to the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The TPM contains operational policy necessary to implement Title 32 to the Code of Federal Regulations Part 199 (32 CFR 199). This manual augments the 32 CFR 199 and must be used in conjunction, for complete policy information.

NOTE

The Managed Care Support (MCS) Manuals for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each manuals' web page. Select the desired manual below, then proceed to the "Superseded" manual(s) that exist below the "Current" manual.

  • April 1, 2015 Edition
    Last Updated: December 6, 2022
    Most Recent Change Number: Change 105
    These manuals are applicable to the East and West Regional Managed Care Support Contracts awarded on or after 07/21/2016. Upon direction of the Contracting Officer, all or portions of these manuals may also apply to the TRICARE Quality Monitoring Contract (TQMC), TRICARE Claims Audit Review Services (TCARS), TRICARE Overseas Program (TOP), TRICARE Pharmacy (TPharm), TRICARE Dental Program (TDP), and TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC).
    This edition reissued the February 1, 2008 edition. All changes to the February 1, 2008 edition of the TPM (through Change 272 dated October 19, 2022) have been incorporated.
    All future changes will be published to this edition.

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    This change adds a new section to include updates to coverage criteria for non-surgical treatments for Gender Dysphoria.
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  • February 1, 2008 Edition - Superseded
    Last Updated: October 19, 2022
    Most Recent Change Number: Change 272
    This manual is valid for contracts awarded on or after June 27, 2008 for the North, South, and West Regions along with TQMC, CARS, TOP, and TPharm. The manuals will apply to the TDEFIC contract upon direction of the Contracting Officer.
    A listed procedure may be cost-shared only when the contractor determines the procedure is appropriate medical care, is medically or psychologically necessary, is not unproven (see the TPM, Chapter 1, Section 2.1), and the TPM does not explicitly exclude or limit cost-sharing of the procedure.
    This edition supersedes the August 1, 2002 edition. All changes to the August 1, 2002 edition (through Change 175 dated April 3, 2013) have been incorporated.
    No future changes will be published to this edition.

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    Page Count: 1,106
    See the Change Transmittal. This change is published in conjunction with Feb 2008 TOM Change 289 and Feb 2008 TRM Change 200.
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  • August 1, 2002 Edition - Superseded
    Last Updated: April 3, 2013
    Most Recent Change Number: Change 175
    This manual is valid for contracts awarded on or after May 1, 2003 through June 26, 2008 for the North, South, and West Regions along with TDEFIC, NQMC, CARS, Retail, and TMOP.
    The August 1, 2002 edition of the TRICARE Policy Manual (TPM), 6010.54-M, is available online. This edition supersedes the June 25, 1999 edition. All changes to the June 25, 1999 edition (through Change 22 dated April 30, 2004) have been incorporated.
    No future changes will be published to this edition.

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    Page Count: 1,144
    See the Change Transmittal. This change is published in conjunction with Aug 2002 TRM Change 159 and Aug 2002 TSM Change 102.
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