3.1 Mental Health Diagnosis and
Treatment
3.1.1 A
diagnosis of gender dysphoria GD must
be made by a TRICARE-authorized mental health provider according
to most current edition of the DSM.
3.1.2 Psychotherapy
for gender dysphoria GD and
psychotherapy rendered for patients pursuing transition (e.g., during
“Real-Life Experience,” or RLE) by a TRICARE-authorized mental health
provider is covered.
3.1.3 Consistent
with mental health treatment for other disorders, outpatient, office-based,
mental health visits do not require a referral or preauthorization.
Note: Active duty membersADSMs 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 active duty members.
3.1.4 Treatment
team conferences (Current Procedural Terminology (CPT) codes 99366,
99367, and 99368) may be covered.
3.2 Endocrine
Treatment
3.2.1 Hormone Therapy for Adults
CrossGender-Affirming
Hormone Therapy (GAHT), also known as cross-sex hormone
treatment is authorized in adults is
authorized if they:
3.2.1.1 Have a diagnosis of
gender
dysphoria GD as described
in
paragraph 3.1.1;
3.2.1.2 Have no psychiatric comorbidity
that would confound a diagnosis of gender dysphoria GD or interfere
with treatment (e.g., unresolved body dysmorphic disorder; schizophrenia
or other psychotic disorders that have not been stabilized with
treatment); and
3.2.1.3 Have a documented minimum of
three months of RLE and/or three months of continuous psychotherapy
addressing gender transition as an intervention for gender
dysphoria GD.
3.2.2 Hormone Therapy for Adolescents
Cross-sex hormone
treatmentGAHT is authorized in
adolescents is authorized if they:
3.2.2.1 Have a diagnosis of
gender
dysphoria GD as described
in
paragraph 3.1.1;
3.2.2.2 Have experienced puberty to
at least Tanner Stage 2;
3.2.2.3 Are 16 years or older;
3.2.2.4 Have no psychiatric comorbidity
that would confound a diagnosis of gender dysphoria GD or interfere
with treatment (e.g., unresolved body dysmorphic disorder; schizophrenia
or other psychotic disorders that have not been stabilized with
treatment); and
3.2.2.5 Have a documented minimum of
three months RLE and/or three months of continuous psychotherapy
addressing gender transition as an intervention for gender
dysphoria GD.
3.2.3 Pubertal Suppression
3.2.3.1 Because a diagnosis
of gender dysphoria in a prepubertal child may resolve (a majority
of childhood cases do not persist into adolescence), endocrineEndocrine treatment
of prepubertal children is not medically indicated until
there is evidence of puberty (i.e., prior to Tanner
Stage 2) and therefore is not authorized.
3.2.3.2 Adolescents who have experienced
puberty to at least Tanner Stage 2 may be treated by suppressing puberty
with gonadotropin-releasing hormone (GnRH) analogues until age 16
years old, after which cross-sex hormones GAHT may
be given.