TRICARE covers the use of telecommunications technology to provide medically and psychologically necessary services to beneficiaries across distances. TRICARE defines medical/psychological necessity as appropriate, reasonable and adequate care for the patient's condition (see Regulation 32 CFR 199).
Specific technical requirements, outlined in TRICARE Policy Manual, Chapter 7, Section 22.1, must be met. See "Technical Requirements" below.
Providers must follow professional discipline and national practice guidelines when practicing via telehealth. In addition, providers must have processes in place for handling emergency situations when starting telehealth treatment.
For information on which applied behavior analysis (ABA) services may be rendered via telehealth under the Autism Care Demonstration, visit our ABA Service Locations page.
Note: Christian Science services are excluded from the telehealth benefit. To be considered for coverage under TRICARE, the beneficiary must be physically present when a Christian Science service is rendered.
In order to be reimbursed for telehealth under TRICARE, the provider must be a TRICARE-authorized provider and the services rendered must be within the provider's scope of practice under all applicable state(s) law(s) in which services are provided and/or received.
Telephonic (Audio-Only) and Audio/Video Telehealth
Medically or psychologically necessary telehealth services may be synchronous (two-way audio and video, such as real-time video), asynchronous (one direction at a time, such as submitting medical history from one party to another), or telephonic only.
Exception: Audio-only services are not allowed under the Autism Care Demonstration. Parent/caregiver guidance performed via telemedicine must be rendered using audio AND video platforms. Learn more on our ABA Service Locations page.
Audio-only telehealth can be for provider-to-patient care or for clinical consultations between providers that is specific to a patient’s care. Providers should document in the medical records why audio only was chosen in lieu of an audio/video combination. Audio-only telehealth should not be used for care that normally requires a physical examination or a visual evaluation.
Telemedicine services do not include texting.
Services provided via telemedicine follow the same approval criteria and limitations that apply to in-person medical and psychological services. You do not need a new or separate approval to render already-authorized services via telemedicine.
Copayments and Cost-Shares
Copayments and cost-shares for covered telemedicine services are the same as those for in-person visits. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to point-of-service costs.
Video Conferencing Platforms
Video conferencing platforms used for telemedicine services must have the appropriate verification, confidentiality, and security parameters necessary to be properly utilized for this purpose and must meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Video-chat applications (for example, Skype and Facetime) may not meet such requirements and should not be used unless appropriate measures are taken to ensure the application meets these requirements and that appropriate business associates agreements (if necessary) are in place to utilize such applications for telemedicine.
Telemedicine services provided through personal computers or mobile devices that use internet-based videoconferencing software programs must provide such services at a bandwidth and with sufficient resolutions to ensure the quality of the image and/or audio received is sufficient for the type of telemedicine services being delivered. Providers should establish an alternate plan to communicate with patients in the event of a technological failure. This plan should be presented to the patient at the beginning of the appointment. Providers should only resume telemedicine services if all technological requirements are restored.
Privacy and Security
- Providers shall ensure audio and video transmissions used are secured using point-to-point encryption that meets recognized standards.
- Providers shall not utilize video conference software that allows multiple concurrent sessions to be opened by a single user.
- Protected Health Information (PHI) and other confidential data shall only be backed up to or stored on secure data storage locations that have been approved for this purpose.
- For synchronous telehealth services, providers shall implement a means for verifying patient identity.
View the TRICARE Policy Manual, Chapter 7, Section 22.1 for additional information.