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TRICARE Policy Manual 6010.63-M, April 2021
Providers
Chapter 11
Section 4.1
Unauthorized Institution: Related Professional Services
Issue Date:  January 26, 1987
Authority:  32 CFR 199.6(c)
Revision:  
1.0  POLICY
Otherwise covered services rendered by an authorized professional provider who is not employed by or contracted with the institution may be cost-shared even though the medical services were furnished in an unauthorized institution for which benefits cannot be extended.
2.0  EXCLUSION
Inpatient mental health services, partial hospitalization, or any other care that falls under the waiver of liability provision. For example, when preauthorization is required as for inpatient mental health services and partial hospitalization and has not been obtained, payment may not be made for any of the services, either institutional or those rendered by an authorized professional provider who is not employed or contracted with the institution.
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