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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 7
Section 1.1
Sexual Dysfunctions And Paraphilic Disorders
Issue Date:  November 1, 1983
Authority:  32 CFR 199.4(e)(8)(ii)(D), (g)(29), and (g)(30); and Title 10, United States Code (USC) 1079(a)(9) and (11)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-1, March 10, 2017
1.1  Sexual dysfunctions are characterized by disturbance in sexual desire and in the psychophysiologic changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty. The sexual dysfunctions include sexual desire disorders (e.g., hypoactive sexual desire disorder, sexual aversion disorder), sexual arousal disorders (e.g., female sexual arousal disorder, male erectile disorder), orgasmic disorders (e.g., female orgasmic disorder, male orgasmic disorder, premature ejaculation), sexual pain disorders (e.g., dyspareunia, vaginismus), sexual dysfunction due to a general medical condition, substance-induced sexual dysfunction, and sexual dysfunction not otherwise specified. The origin of these disorders may be organic or psychogenic.
1.2  Paraphilic disorders are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Paraphilic disorders include voyeuristic disorder, exhibitionistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, fetishistic disorder, other specified paraphilic disorder, and unspecified paraphilia disorder.
Diagnostic studies necessary to establish organic versus psychogenic disorders, and appropriate medical and surgical treatment related to sexual dysfunctions including sexual disinhibition with an organic origin (e.g., disease, trauma, injury, or radical surgery) may be cost-shared under the TRICARE Program.
3.1  Non-medical (psychiatric) services for organic sexual dysfunction.
3.2  Services and supplies provided in connection with psychotherapy for sexual dysfunctions and paraphilic disorders. Therapy that is wholly or partially related to treating sexual dysfunctions, such as sex therapy, sexual advice, sexual counseling, sex behavior modification, psychotherapy, or other similar services.
3.3  All services and supplies directly and indirectly related to surgical treatment for gender dysphoria (i.e., sex gender change), except when performed to correct ambiguous genitalia, which is documented to have been present at birth (CPT procedure codes 55970 and 55980).
February 1, 1988.
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