2.0
hcpcs Procedure
Codes
A4520, T1013, T4521 - T4536, T4539, T4543
- T4544
3.0 POLICY
3.1 Assistive services.
Subject to all applicable requirements, TRICARE may cost-share the
services of a qualified interpreter or translator for ECHO beneficiaries
who are deaf and/or mute, readers for ECHO beneficiaries who are
blind, and personal assistants for ECHO beneficiaries with other
types of qualifying conditions, when such services are necessary
to the rendering or delivery of an authorized ECHO service or item.
3.2 Equipment adaptation.
Subject to all applicable requirements, TRICARE may cost-share such services
and structural modification to the equipment as necessary to make
the equipment serviceable for a particular disability.
3.3 Equipment maintenance.
Reasonable repairs and maintenance for that portion of the useful
life of beneficiary owned equipment that was cost-shared through
the ECHO and is concurrent with the beneficiary’s ECHO eligibility
may be cost-shared as an ECHO benefit subject to all applicable requirements.
3.4 Personal
incontinence supplies (i.e., diapers) that support skin integrity
and prevent deterioration of skin due to incontinence may be cost-shared
as medical supplies for ECHO beneficiaries age three and older who
are incontinent as a result of spinal, neurologic, and/or mobility issues,
subject to all other applicable ECHO requirements. Authorization
requirements and ECHO monthly cost-shares and fiscal year caps apply.
Refer to
Chapter 11, Section 9.1 for receipt requirements and
a description of appropriate vendors. Reimbursement for personal
incontinence supplies (i.e., diapers) shall be made at the lesser
of the billed charge or negotiated rate giving consideration for
the base purchase price, applicable tax and shipping. To be eligible
for reimbursement, personal incontinence supplies must be purchased
for exclusive use by an ECHO beneficiary who meets the eligibility
criteria stated above.
4.0 EXCLUSIONs
4.1 Services available
under the TRICARE Basic Program are not eligible to be cost-shared
under the ECHO.
4.2 Service animals (seeing eye dogs, hearing/handicap
assistance dogs, seizure and other detection animals, service monkeys,
etc.) are excluded from coverage.
4.3 Personal incontinence supplies, for infants
and children under age three, are not eligible to be cost-shared
under the ECHO.
4.4 Personal incontinence supplies not specifically
identified under
paragraph 2.0 (e.g., diaper creams, bed pads,
etc.) are excluded from coverage. This includes (but is not limited
to) any supplies identified with codes E1399 and A4335 (miscellaneous
Durable Medical Equipment (DME)).
5.0 EFFECTIVE
DATEs
5.1 September
1, 2005, for benefits other than personal incontinence
supplies.
5.2 October 1, 2015, for personal incontinence.