Please refer to the COVID 19 Testing, Treatment and Vaccination Reimbursement Policy for information regarding coding and reimbursement for COVID testing, treatment and vaccinations.
TRICARE covers the cost of at-home test kits that are authorized by the FDA and ordered by a Johns Hopkins USFHP-authorized provider for a medically necessary purpose, such as exhibition of symptoms. As a reminder, TRICARE reminds all beneficiaries to follow currently approved TRICARE requirements for COVID-19 testing. Please see the applicable TRICARE Policy for details.
Referrals are required for COVID-19 testing.
USFHP does not cover a test that is not primarily intended for diagnosis and/or treatment of COVID-19. This includes:
- Public health surveillance
- General workplace health and safety
- Return to school
- Mass transportation (e.g. bus, train, vanpool)
- Personal or leisure travel
- Curiosity or personal interest
- Early refill restrictions are waived on prescription for at least 30-day supplies.
- Members can also consider getting a 90-day supply of maintenance medications they take on a regular basis. Visit the USFHP pharmacy page to learn more about prescription coverage.
Please refer to the TRICARE Policy for details on telehealth as well as billing guidelines. View the revised DHA Telehealth Guidance here.
Effective September 6, 2022:
- Audio-only telephone services covered. Telephonic office visits included under the member’s USFHP benefit plan are covered permanently.
- Codes 98966-98968, 99441-99443, G2012 covered per TRICARE Policy Manual (TPM). Please note that USFHP specialty provider visits require the referring PCP’s NPI number on the claim submission.
- Telephonic consultations covered. Telephonic consultations are covered permanently.
- Codes 99446-99449, 99451, and 99452 covered per TPM.
- No prior authorization required.
- Telemedicine copay waiver ends. The temporary waiver of copays and cost-shares for telemedicine services, including telephonic office visits, ends on Sept. 6, 2022.
- Providers can collect copays and cost-shares for telemedicine from USFHP members at the time of service.
For more information of these USFHP changes, please refer to TRICARE Policy Manual 6010.60-M Chapter 2 Section 1.1* and TRICARE Policy Manual 6010.60-M Chapter 2 Section 5.1*.
*This link is from an external website that is not provided or maintained by or in any way affiliated with JHHC. Please note JHHC does not guarantee the accuracy, relevance, timeliness, or completeness of any information on this external website.
- We ask providers to use the POS code that represents the location from which he/she rendered the telemedicine visit (for example, POS 11 if services are rendered from the provider’s office). CMS 1500 professional and UB04 telemedicine claims must still contain one of the telemedicine GT, GQ or 95 modifiers. Telemedicine is covered, originating site can be member’s home, provider can be at office or facility, including an Urgent Care Center. TRICARE® policy does not exclude the provider’s home as distant site. Unless State law prohibits the service from home via telehealth it would be covered. Telemedicine services include office visits, preventative health screenings, telemental health services (individual psychotherapy, psychiatric diagnostic interviews and exams and medication management) and services for End Stage Renal Disease.
- Continuing PT/OT can be covered when performed via telehealth. This benefit is only for continuing therapy, not initial therapy. Speech Therapy via telemedicine can be covered for initial evaluations and continuing therapy.
- Same authorization requirements apply for telemedicine as for face-to-face visits; special authorization not required because service being delivered via telemedicine.
Other important telehealth coverage notes:
- Providers should use POS 02 with no modifier for an audio-only telephone visit
- Relaxing of professional licensing to allow interstate licensing if applicable federal and state law permits.
- G2025: For telehealth distant site services furnished between July 1, 2020, and the end of the COVID-19 Public Health Emergency, RHCs and FQHCs will use an RHC/FQHC specific G code, G2025, to identify services that were furnished via telehealth. Reimbursement $92.
Applied Behavior Analysis (ABA) for Autism Care Demonstration (ACD)
The DHA has authorized an exception to Autism Care Demonstration (ACD) policy regarding the use of telehealth to address the concerns of Applied Behavior Analysis (ABA) providers during the COVID-19 pandemic across the globe.
For details, please see the guidance in the TRICARE® Operations Manual Change 85 or contact USFHP’s Behavioral Health Team at 410-424-4830 or 888-281-3186.