Skip to main content
Military Health System
MHS Home
Utility Navigation Links
TRICARE.MIL
Main Navigation
Home
Manuals
Change History
Manuals by Date
Search
Help
Home
Manuals
TRICARE Program Manuals - 2021 Edition (T-5)
TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Policy Manual 6010.63-M, April 2021
TRICARE Reimbursement Manual 6010.64-M, April 2021
TRICARE Systems Manual 7950.4-M, April 2021
TRICARE Program Manuals - 2015 Edition (T-2017)
TRICARE Operations Manual 6010.59-M, April 2015
TRICARE Policy Manual 6010.60-M, April 2015
TRICARE Reimbursement Manual 6010.61-M, April 2015
TRICARE Systems Manual 7950.3-M, April 2015
Other Manuals
32 CFR 199 (DHA Version), December 2016
DoD Women, Infants, and Children (WIC) Overseas Program Policy Manual, July 2017
Duplicate Claims System (DCS) User Guide, June 2017
10 USC 55 (DHA Version), January 2007
Change History
Manuals by Date
Search
Help
Need larger text?
MHS Home
>
TRICARE Policy Manual 6010.63-M, April 2021
>
Table of Contents
Table of Contents
TRICARE Policy Manual 6010.63-M, April 2021, Baseline (December 5, 2022)
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 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 -- Emergency Department (ED) Services
Sect 3.2 -- Neonatal And Pediatric Critical Care Services
Sect 4.1 -- Consultations
Sect 4.2 -- Anticoagulant Management
Sect 5.1 -- Patient Transport
Sect 6.1 -- Physician Standby Charges
Sect 7.1 -- 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 (MV) 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 4.1 -- Drug Testing
Chap 7 -- Medicine
Sect 1.1 -- Sexual Dysfunctions And Paraphilic Disorders
Sect 1.2 -- Gender Dysphoria
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 -- Treatment Of Mental Disorders - General
Sect 3.8 -- Ancillary Inpatient Mental Health Services
Sect 3.9 -- Psychological Testing
Sect 3.10 -- Psychotherapy
Sect 3.11 -- Family Therapy
Sect 3.12 -- Psychotropic Pharmacologic Management
Sect 3.13 -- Collateral Visits
Sect 3.14 -- Eating Disorder Treatment
Sect 3.15 -- Intensive Outpatient Program (IOP)
Sect 3.16 -- Opioid Treatment Program (OTP)
Sect 3.17 -- 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 Otorhinolaryngologic Services
Sect 8.2 -- Hearing Aids And Hearing Aid Services
Sect 8.3 -- Prosthetic Hearing 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
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 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 -- Medically Necessary Food - For Dates Of Service On Or After December 23, 2017
Sect 7.2 -- 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: Intellectual Disability
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 Care 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/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 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 (PA)
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 (CSP) 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 (US) 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
You are leaving Health.mil
The appearance of hyperlinks does not constitute endorsement by the Defense Health Agency of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.
You are leaving Health.mil
View the external links disclaimer
.
OK
Cancel
Follow us on Instagram
Follow us on LinkedIn
Follow us on Facebook
Follow us on Twitter
Follow us on YouTube
Sign up on GovDelivery
Health.mil logo
Health.mil logo