Medically or psychologically
necessary and appropriate medical care (as defined in
32
CFR 199.2), including non-surgical treatments for GD,
are covered when provide by a TRICARE-authorized provider.
2.1 Mental Health Treatment
2.1.1 Psychotherapy
for the treatment of GD and psychotherapy for beneficiaries pursuing
transition are covered.
2.1.2 Consistent with mental health
treatment for other diagnoses, outpatient, office-based, mental
health visits shall not require a referral or preauthorization.
2.1.3 Treatment
team conferences (Common Procedural Terminology (CPT) codes 99366,
99367, and 99368) are covered.
Note: Active Duty Service Members
(ADSMs) require Military Medical Treatment Facility (MTF) referral/authorization
or Specified Authorized Staff (SAS) preauthorization prior to receiving
non-emergency health care services (other than primary health care
for members enrolled in TRICARE Prime Remote (TPR)) in the private
sector. The contractor shall comply with the provisions of the TRICARE
Operations Manual (TOM),
Chapters 16 and
17 when
processing requests for ADSMs.
2.2 Endocrine
Treatment
Gender-affirming
hormone therapy, also known as cross-sex hormone treatment, is covered
for adult or adolescent beneficiaries when all of the following
criteria are met:
• The beneficiary meets the eligibility
criteria outlined in the most current version of the Endocrine Society Clinical
Practice Guidelines for Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent
Persons.
• The beneficiary has no contraindications
to gender-affirming hormone therapy.
Note: Endocrine treatment includes
pubertal suppression.