Psychological testing and assessment is a covered benefit when medically or psychologically necessary and is provided in conjunction with otherwise covered psychotherapy or as a required part of the assessment and reassessment process for applied behavior analysis.
An approval from Health Net Federal Services, LLC (HNFS) is required for active duty service members (ADSMs). All other TRICARE Prime beneficiaries (excluding ADSMs) do not require an approval when seeing a network provider. TRICARE Prime beneficiaries must have an approval from HNFS to a non-network provide unless they choose to use their Point of Service option. TRICARE Select beneficiaries do not require an approval from HNFS.
When required, authorizations will include 22 units for CPT® code range 96130–96146; however, CPT code 96137 is limited to 11 units per day.
Psychological testing is not covered when used for academic or vocational placement or assessment, when used to evaluate non-covered disorders (for example, learning disorders) or when used to assess intelligence in the absence of a need to diagnose or plan treatment for a covered psychiatric disorder.