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.