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TRICARE Policy Manual 6010.60-M, April 2015
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Table of Contents
Table of Contents
TRICARE Policy Manual 6010.60-M, April 2015, Change 128 (June 4, 2024)
Foreword
Chap 1 -- Administration
Sect 1.1 -- General Policy And Responsibilities
Sect 1.2 -- Exclusions
Sect 1.3 -- Court-Ordered Care
Sect 2.1 -- Unproven Drugs, Devices, Medical Treatments, And Procedures
Sect 3.1 -- Rare Diseases
Sect 4.1 -- Waiver Of Liability
Sect 5.1 -- Requirements For Documentation Of Treatment In Medical Records
Sect 5.2 -- Medical Photography
Sect 6.1 -- Special Authorization Requirements
Sect 7.1 -- Primary Care Managers (PCMs)
Sect 8.1 -- Department Of Veterans Affairs/Veterans Health Administration (DVA/VHA) And Department Of Defense/Defense Health Agency (DoD/DHA) Health Care Resources Sharing
Sect 9.1 -- Individual Case Management Program For Persons With Extraordinary Conditions (ICMP-PEC)
Sect 10.1 -- Category II Codes - Performance Measurement
Sect 11.1 -- Category III Codes - Temporary Codes For Emerging Technology, Services And Procedures
Sect 12.1 -- Healthcare Common Procedure Coding System (HCPCS) "C" And "S" Codes
Sect 13.1 -- Relationship Between TRICARE And Employer-Sponsored Group Health Plans (GHPs)
Sect 14.1 -- Transitional Care Management Services
Sect 14.2 -- Chronic Care Management (CCM) Services
Sect 14.3 -- Advance Care Planning (ACP) Services
Sect 15.1 -- TRICARE Coverage and Payment for Certain Services in Response to the Coronavirus Disease 2019 (COVID-19) Pandemic
Chap 2 -- Evaluation And Management
Sect 1.1 -- Office Visits
Sect 1.2 -- Office Visits With Surgery
Sect 2.1 -- Hospital Care
Sect 2.2 -- Inpatient Concurrent Care
Sect 2.3 -- Outpatient Observation Stays
Sect 3.1 -- Skilled Nursing Facility (SNF) Visits
Sect 4.1 -- Emergency Department (ED) Services
Sect 4.2 -- Neonatal And Pediatric Critical Care Services
Sect 5.1 -- Consultations
Sect 5.2 -- Anticoagulant Management
Sect 6.1 -- Patient Transport
Sect 7.1 -- Physician Standby Charges
Sect 8.1 -- Remote Physiologic Monitoring (RPM)
Chap 3 -- Anesthesia
Sect 1.1 -- Anesthesia
Sect 1.2 -- Moderate (Conscious) Sedation
Chap 4 -- Surgery
Sect 1.1 -- Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment
Sect 1.2 -- Treatment Of Unfortunate Sequelae And/Or Medically Necessary Follow-On Care Subsequent To Authorized Noncovered Initial Surgery Or Treatment In A Market/Military Medical Treatment Facility (MTF)
Sect 2.1 -- Cosmetic, Reconstructive, And Plastic Surgery - General Guidelines
Sect 2.2 -- General Surgery
Sect 3.1 -- Laser Surgery
Sect 3.2 -- Robotic Surgery
Sect 4.1 -- Assistant Surgeons
Sect 5.1 -- Integumentary System
Sect 5.2 -- Post-Mastectomy Reconstructive Breast Surgery and Breast Prostheses
Sect 5.3 -- Prophylactic Mastectomy, Prophylactic Oophorectomy, And Prophylactic Hysterectomy
Sect 5.4 -- Reduction Mammaplasty For Macromastia
Sect 5.5 -- Silicone Or Saline Breast Implant Removal
Sect 5.6 -- Breast Reconstruction As A Result Of A Congenital Anomaly
Sect 5.7 -- Gynecomastia
Sect 5.8 -- Negative Pressure Wound Therapy (NPWT)
Sect 6.1 -- Musculoskeletal System
Sect 6.2 -- Bone Growth Stimulation
Sect 7.1 -- Oral Surgery
Sect 8.1 -- Respiratory System
Sect 8.2 -- Lung Volume Reduction Surgery (LVRS)
Sect 9.1 -- Cardiovascular System
Sect 9.2 -- Photopheresis
Sect 9.3 -- Intracoronary Stents
Sect 9.4 -- Therapeutic Apheresis
Sect 10.1 -- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Sect 11.1 -- Hemic And Lymphatic Systems
Sect 12.1 -- Mediastinum And Diaphragm
Sect 13.1 -- Digestive System
Sect 13.2 -- Surgery For Morbid Obesity
Sect 14.1 -- Urinary System
Sect 15.1 -- Male Genital System
Sect 16.1 -- Intersex Surgery
Sect 17.1 -- Female Genital System
Sect 18.1 -- Maternity Care
Sect 18.2 -- Antepartum Services
Sect 18.3 -- Abortions
Sect 18.4 -- Cesarean Sections
Sect 18.5 -- Fetal Surgery
Sect 19.1 -- Endocrine System
Sect 20.1 -- Nervous System
Sect 20.2 -- Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson’s Disease
Sect 20.3 -- Stereotactic Radiofrequency Thalamotomy
Sect 21.1 -- Eye And Ocular Adnexa
Sect 22.1 -- Auditory System
Sect 22.2 -- Cochlear Implantation
Sect 23.1 -- High Dose Chemotherapy (HDC) And Stem Cell Transplantation
Sect 24.1 -- Heart-Lung And Lung Transplantation
Sect 24.2 -- Heart Transplantation
Sect 24.3 -- Combined Heart-Kidney Transplantation (CHKT)
Sect 24.4 -- Small Intestine (SI), Combined Small Intestine-Liver (SI/L), And Multivisceral Transplantation
Sect 24.5 -- Liver Transplantation
Sect 24.6 -- Combined Liver-Kidney Transplantation (CLKT)
Sect 24.7 -- Simultaneous Pancreas-Kidney (SPK), Pancreas-After-Kidney (PAK), And Pancreas-Transplant-Alone (PTA), And Pancreatic Islet Cell Transplantation
Sect 24.8 -- Kidney Transplantation
Sect 24.9 -- Donor Costs
Chap 5 -- Radiology
Sect 1.1 -- Diagnostic Radiology (Diagnostic Imaging)
Sect 2.1 -- Diagnostic Ultrasound
Sect 2.2 -- Radiologic Guidance
Sect 3.1 -- Radiation Oncology
Sect 3.2 -- Brachytherapy/Radiation Therapy
Sect 3.3 -- Hyperthermia
Sect 4.1 -- Nuclear Medicine
Sect 5.1 -- Thermography
Chap 6 -- Pathology And Laboratory
Sect 1.1 -- General
Sect 2.1 -- Transfusion Services For Whole Blood, Blood Components, And Blood Derivatives
Sect 3.1 -- Genetic Testing And Counseling
Sect 3.2 -- Preconception And Prenatal Carrier Screening Tests
Sect 4.1 -- Drug Testing
Chap 7 -- Medicine
Sect 1.1 -- Sexual Dysfunctions And Paraphilic Disorders
Sect 1.2 -- Gender Dysphoria (GD) Health Care For Dates of Service On or Before June 30, 2022
Sect 1.3 -- Gender Dysphoria (GD) and Gender-Affirming Health Care For Dates of Service On or After July 1, 2022
Sect 2.1 -- Clinical Preventive Services - TRICARE Basic Program Benefits
Sect 2.2 -- Clinical Preventive Services - TRICARE Prime And TRICARE Select
Sect 2.3 -- Family Planning
Sect 2.4 -- Cervical Cancer Screening
Sect 2.5 -- Well-Child Care
Sect 2.6 -- Chelation Therapy
Sect 2.7 -- Hydration, Therapeutic, Prophylactic, And Diagnostic Injections And Infusions
Sect 3.1 -- Acute Hospital Psychiatric Care
Sect 3.2 -- Psychiatric Residential Treatment Center (RTC) Care
Sect 3.3 -- Inpatient/Residential Substance Use Disorder (SUD) Detoxification And Rehabilitation
Sect 3.4 -- Psychiatric And Substance Use Disorder (SUD) Partial Hospitalization Programs (PHPs)
Sect 3.5 -- Substance Use Disorders (SUDs) - General
Sect 3.6 -- Specific Learning Disorders
Sect 3.7 -- Attention-Deficit/Hyperactivity Disorder
Sect 3.8 -- Treatment Of Mental Disorders - General
Sect 3.9 -- Ancillary Inpatient Mental Health Services
Sect 3.10 -- Psychological Testing
Sect 3.11 -- Psychotherapy
Sect 3.12 -- Family Therapy
Sect 3.13 -- Psychotropic Pharmacologic Management
Sect 3.14 -- Collateral Visits
Sect 3.15 -- Eating Disorder Treatment
Sect 3.16 -- Intensive Outpatient Program (IOP)
Sect 3.17 -- Opioid Treatment Program (OTP)
Sect 3.18 -- Medication Assisted Treatment (MAT)
Sect 4.1 -- Biofeedback
Sect 4.2 -- Dialysis
Sect 5.1 -- Gastroenterology
Sect 6.1 -- Ophthalmological Services
Sect 6.2 -- Lenses (Intraocular Or Contact) And Eye Glasses
Sect 6.3 -- Cardiovascular Therapeutic Services
Sect 7.1 -- Speech Services
Sect 8.1 -- Special Otorhinolarygologic Services
Sect 8.2 -- Hearing Aids And Hearing Aid Services
Sect 8.3 -- Auditory Osseointegrated Implant (AOI) Devices
Sect 9.1 -- Electronystagmography (ENG)
Sect 10.1 -- Echocardiogram For Dental And Invasive Procedures
Sect 11.1 -- Cardiac Rehabilitation
Sect 12.1 -- Non-Invasive Vascular Diagnostic Studies
Sect 13.1 -- Pulmonary Services
Sect 14.1 -- Allergy Testing And Treatment
Sect 15.1 -- Neurology And Neuromuscular Services
Sect 15.2 -- Sensory Evoked Potentials (SEP)
Sect 16.1 -- Central Nervous System (CNS) Assessments/Tests
Sect 16.2 -- Health And Behavior Assessment/Intervention
Sect 16.3 -- Chemotherapy Administration
Sect 16.4 -- Education And Training For Patient Self Management
Sect 17.1 -- Dermatological Procedures - General
Sect 18.1 -- Rehabilitation - General
Sect 18.2 -- Physical Medicine/Therapy
Sect 18.3 -- Occupational Therapy
Sect 18.4 -- Osteopathic Manipulative Therapy
Sect 18.5 -- Chiropractic Manipulative Treatment (CMT)
Sect 19.1 -- Diagnostic Sleep Studies
Sect 20.1 -- Hyperbaric Oxygen (HBO) Therapy
Sect 21.1 -- Chronic Fatigue Syndrome (CFS)
Sect 22.1 -- Telemedicine/Telehealth
Sect 23.1 -- Augmentative Communication Devices (ACDs)
Sect 24.1 -- Phase I, Phase II, And Phase III Cancer Clinical Trials
Sect 24.2 -- Coronavirus Disease 2019 (COVID-19) Clinical Trials
Sect 25.1 -- Dermoscopy
Sect 26.1 -- Forensic Examinations Following Sexual Assault or Domestic Violence
Sect 27.1 -- Botulinum Toxin Injections
Chap 8 -- Other Services
Sect 1.1 -- Ambulance Service
Sect 2.1 -- Durable Equipment (DE): Basic Program
Sect 2.2 -- Infantile Apnea Cardiorespiratory Monitor
Sect 2.3 -- External And Implantable Infusion Pumps
Sect 2.4 -- Cold Therapy Devices For Home Use
Sect 2.5 -- Home Prothrombin Time (PT) International Normalized Ratio (INR) Monitor
Sect 2.6 -- Breast Pumps, Breast Pump Supplies, And Breastfeeding Counseling
Sect 2.7 -- Pulsed Irrigation Evacuation (PIE)
Sect 2.8 -- Blood Pressure Monitors
Sect 3.1 -- Orthoses (Braces And Splints)
Sect 4.1 -- Prosthetic Devices And Supplies
Sect 5.1 -- Medical Devices
Sect 5.2 -- Neuromuscular Electrical Stimulation (NMES) Devices
Sect 5.3 -- Continuous Glucose Monitoring System (CGMS) Devices
Sect 5.4 -- Automated External Defibrillators (AEDs)
Sect 6.1 -- Medical Supplies And Dressings (Consumables)
Sect 7.1 -- Nutritional Therapy - For Dates Of Service On or Before December 22, 2017
Sect 7.2 -- Medically Necessary Food - For Dates Of Service On Or After December 23, 2017
Sect 7.3 -- Liquid Protein Diets
Sect 8.1 -- Diabetes Self-Management Training (DSMT) Services
Sect 8.2 -- Therapeutic Shoes For Diabetics
Sect 9.1 -- Pharmacy Benefits Program
Sect 10.1 -- Oxygen And Oxygen Supplies
Sect 11.1 -- Podiatry
Sect 12.1 -- Wigs Or Hairpiece
Sect 13.1 -- Adjunctive Dental Care
Sect 13.2 -- Dental Anesthesia And Institutional Benefit
Sect 14.1 -- Physician-Assisted Suicide
Sect 15.1 -- Custodial Care Transitional Policy (CCTP)
Sect 16.1 -- Mucus Clearance Devices
Sect 17.1 -- Lymphedema
Sect 18.1 -- Continuous Passive Motion (CPM) Devices
Sect 19.1 -- Smoking Cessation Counseling
Sect 20.1 -- Infusion Drug Therapy Delivered In The Home
Chap 9 -- Extended Care Health Option (ECHO)
Sect 1.1 -- General
Sect 2.1 -- Eligibility - General
Sect 2.2 -- Eligibility - Qualifying Condition: Mental Retardation
Sect 2.3 -- Eligibility - Qualifying Condition: Serious Physical Disability
Sect 2.4 -- Eligibility - Qualifying Condition: Other
Sect 3.1 -- Registration
Sect 4.1 -- Benefit Authorization
Sect 5.1 -- Public Facility Use Certification
Sect 6.1 -- Diagnostic Services
Sect 7.1 -- Treatment
Sect 8.1 -- Training
Sect 9.1 -- Special Education And Other Services
Sect 10.1 -- Institutional Care
Sect 11.1 -- Transportation
Sect 12.1 -- Extended Care Health Option (ECHO) Respite Care
Sect 13.1 -- Other Extended Care Health Option (ECHO) Benefits
Sect 13.2 -- Other Extended Care Health Option (ECHO) Benefits - Hippotherapy
Sect 14.1 -- Durable Equipment (DE) Prior To January 30, 2015
Sect 14.2 -- Durable Equipment (DE) And Assistive Technology (AT) Devices On Or After January 30, 2015: Extended Care Health Option (ECHO) Program
Sect 15.1 -- ECHO Home Health Care (EHHC)
Sect 16.1 -- Cost-Share Liability
Sect 17.1 -- Providers
Sect 18.1 -- Claims
Chap 10 -- Eligibility And Enrollment
Sect 1.1 -- Eligibility Requirements For TRICARE Beneficiaries
Sect 2.1 -- TRICARE Prime And TRICARE Select Enrollment
Sect 3.1 -- TRICARE Prime/TRICARE Select And Status Changes
Sect 4.1 -- Continued Health Care Benefit Program (CHCBP)
Sect 5.1 -- Transitional Assistance Management Program (TAMP)
Sect 6.1 -- TRICARE For Life (TFL) And Other Medicare-Eligible Beneficiaries
Sect 7.1 -- Transitional Survivor Status And Survivor Status
Sect 8.1 -- Guard And Reserve Family Member Benefits
Sect 9.1 -- Early Eligibility Benefits For The Reserve Components (RCs)
Sect 10.1 -- TRICARE Coverage For Certain Members of The National Guard (NG)
Chap 11 -- Providers
Sect 1.1 -- Providers - General
Sect 1.2 -- Institutional Provider, Individual Provider, And Other Non-Institutional Provider Participation
Sect 2.1 -- Department of Veterans Affairs/Veterans Health Administration (DVA/VHA) Health Care Facilities
Sect 2.2 -- Employer-Operated Medical Facilities
Sect 2.3 -- Birthing Centers
Sect 2.4 -- Eating Disorder Programs
Sect 2.5 -- Psychiatric And Substance Use Disorder (SUD) Partial Hospitalization Program (PHP) Standards
Sect 2.6 -- Psychiatric Hospitals Accreditation
Sect 2.7 -- Intensive Outpatient Program (IOP) Standards
Sect 2.8 -- Opioid Treatment Program (OTP) Standards
Sect 2.9 -- Residential Treatment Center (RTC) Standards
Sect 2.10 -- Freestanding End Stage Renal Disease (ESRD) Facilities
Sect 3.1 -- Physician Referral And Supervision
Sect 3.2 -- State Licensure And Certification
Sect 3.3 -- Accreditation
Sect 3.4 -- Nurse Anesthetist
Sect 3.5 -- Anesthesiologist Assistant (AA)
Sect 3.6 -- Certified Clinical Social Worker (CSW)
Sect 3.7 -- Certified Psychiatric Nurse Specialist (CPNS)
Sect 3.8 -- Clinical Psychologist
Sect 3.9 -- Certified Marriage And Family Therapist
Sect 3.10 -- Pastoral Counselor
Sect 3.11 -- Mental Health Counselor
Sect 3.12 -- Certified Nurse Midwife (CNM)
Sect 3.13 -- Certified Physician Assistant
Sect 3.14 -- Registered Dietitian (RD)
Sect 3.15 -- Nutritionist
Sect 3.16 -- Physical Therapist Assistants (PTAs)
Sect 3.17 -- Occupational Therapy Assistants (OTAs)
Sect 4.1 -- Unauthorized Institution: Related Professional Services
Sect 4.2 -- Unauthorized Provider: Emergency Services
Sect 5.1 -- Provider Standards For Potentially Human Immunodeficiency Virus (HIV) Infectious Blood And Blood Products
Sect 6.1 -- Ambulatory Surgery
Sect 6.2 -- Freestanding Ambulatory Surgery Center (ASC)
Sect 7.1 -- Certification Of Organ Transplant Centers
Sect 8.1 -- Inpatient/Residential Substance Use Disorder Rehabilitation Facilities (SUDRFs) Standards
Sect 9.1 -- Other Provider Certification
Sect 9.2 -- State Vaccine Programs (SVPs) As TRICARE-Authorized Providers
Sect 10.1 -- Services Rendered By Employees Of Authorized Independent Professional Providers
Sect 11.1 -- Birthing Center Accreditation
Sect 11.2 -- Birthing Center Certification Process
Sect 11.3 -- Certified Marriage And Family Therapist Certification Process
Sect 12.1 -- Corporate Services Provider Class
Sect 12.2 -- Qualified Accreditation Organization
Sect 12.3 -- Participation Agreement Requirements
Addendum A -- Participation Agreement For Certified Marriage And Family Therapist
Addendum B -- Participation Agreement For Freestanding Or Institution-Affiliated Birthing Center (BC) Maternity Care Services
Addendum C -- Application Form For Corporate Services Providers
Addendum D -- Participation Agreement For Inpatient/Residential Substance Use Disorder Rehabilitation Facility (SUDRF) Services For TRICARE Beneficiaries
Addendum E -- Participation Agreement For Residential Treatment Center (RTC)
Addendum F -- Participation Agreement For Freestanding And Substance Use Disorder (SUD) Psychiatric Partial Hospitalization Program (PHP) Services
Addendum G -- Participation Agreement For Intensive Outpatient Program (IOP) Services
Addendum H -- Participation Agreement For Opioid Treatment Program (OTP) Services
Addendum I -- Participation Agreement For Intensive Outpatient Program (IOP) Services as Part of the IOP Pilot for Psychological Health Sequelae of Sexual Trauma
Chap 12 -- TRICARE Overseas Program (TOP)
Sect 1.1 -- TRICARE Overseas Program (TOP)
Sect 1.2 -- TRICARE Overseas Program (TOP) Medical Benefit Variations
Sect 1.3 -- Outside The 50 United States And The District Of Columbia Locality-Based Reimbursement Rate Waiver
Chap 13 -- Provisional Coverage For Emerging Services And Supplies
Sect 1.1 -- Provisional Coverage For Emerging Services And Supplies
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