2.0 POLICY
The Assistant
Secretary of Defense (Health Affairs) (ASD(HA)) issued an Interim
Final Rule (IFR) with comment in the Federal Register on
May 12, 2020, temporarily amending the TRICARE regulation to encourage
social distancing and prevent the spread of COVID-19 by incentivizing
the use of telemedicine services.
2.1 Temporary Coverage of Audio-Only Telephone
Services
Existing regulations exclude TRICARE coverage
of telephone services (audio-only) except for biotelemetry. Given
the CDC guidelines for social distancing and some states governors’
orders for residents to stay at home, an exception to the regulatory
exclusion is permitted. TRICARE-authorized providers are allowed
to render medically necessary care and treatment to beneficiaries
over the telephone, when face-to-face, hands-on treatment is not
medically necessary.
2.1.1 Telephone
services (audio-only) are not excluded when otherwise covered TRICARE services
are provided to a beneficiary through this modality, if the services
are medically or psychologically necessary and appropriate.
2.1.2 Telephone services involving evaluation
and management visits shall be reported utilizing Current Procedural
Terminology (CPT) code 99441-3; 98966-8; Healthcare Common Procedure
Coding System (HCPCS) code G2012.
2.1.3 Other authorized telephone services
(e.g., psychotherapy services) shall be reported with the appropriate
CPT or HCPCS code and with the appropriate modifier or place of
service code (e.g., 02) to report that the care was delivered via
telephone. Place of Service Code 02 is not required for telehealth
claims if a more appropriate Place of Service Code is necessary
for correct billing.
2.1.4 Audio-only
care is inappropriate where a visual connection would be required
to ensure appropriate medical care; e.g., evaluation of a skin lesion
by a dermatologist or intensive outpatient programs.
2.2 Temporary Relaxation of State Professional
Licensing Requirements
2.2.1 In the United States, if applicable
federal or state law permits providers to operate within a jurisdiction
without obtaining a license in that state, services provided to
beneficiaries by an otherwise authorized TRICARE provider may be
cost-shared if that provider holds an equivalent license from any state
in the United States, complies with provisions for interstate practice
in the state where the beneficiary is receiving care, and is not
affirmatively barred or restricted from practicing in any state
in the United States. This temporary change does not supplant state
authority to regulate licensure, but assures that if licensure requirements
are relaxed by any state or the federal government during the period
of the COVID-19 pandemic, that providers caring for TRICARE beneficiaries
in compliance with applicable state or federal law will be eligible
for reimbursement under TRICARE.
2.2.2 For overseas locations, if the host-nation
permits providers to operate within that nation without obtaining
a license in that nation, services provided to beneficiaries by
a TRICARE-authorized provider may be cost-shared if the provider
holds an equivalent license in the nation in which they normally
practice and meets all requirements for practice under the host
nation.
2.2.3 Providers
listed on the Department of Health and Human Services (HHS) sanction
list remain ineligible to provide care under TRICARE.
3.0 EFFECTIVE DATES
3.1 May 12, 2020 for temporary exception to
the prohibition on telephone services in the United States.
3.2 May 12, 2020 for the provision relaxing
professional licensing requirements to allow interstate and international
licensing.
3.3 For
overseas, the effective date is March 10, 2020 for the provisions
identified above.
4.0 EXPIRATION
4.1 For services provided in the United States,
these provisions expire upon expiration of the President’s national
emergency for the COVID-19 outbreak.
4.2 For services provided outside the 50 United
States, District of Columbia, and U.S. Territories including the
Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands, these
provisions expire upon conclusion of the COVID-19 pandemic, as determined
by the ASD(HA).