Infectious Disease Screening and Vaccination
TRICARE covers screening for individuals who have been exposed or are at high risk for several infectious diseases, including hepatitis B and HIV. Pregnant women may be screened for hepatitis B, HIV and rubella antibodies. Beneficiaries at risk for active disease are eligible for screening and/or prophylaxis for tetanus, rabies, hepatitis B and C, meningococcal meningitis, and tuberculosis. See also Immunizations.
Infertility treatment is a limited benefit. More >>
Injection/infusion medication is a limited benefit. More >>
Certain procedures are only payable by TRICARE when performed in an inpatient setting. The Defense Health Agency provides an inpatient-only code list that specifies which services are only paid when performed in an inpatient setting.
Inpatient-only services are not covered when performed in an outpatient, 23-hour observation status or ambulatory setting. Any related services associated with the inpatient-only service are not covered.
Intelligence testing, also known as IQ testing, is a limited benefit and only covered when medically necessary for the diagnosis or treatment planning of covered psychiatric disorders. Cost Information
Intelligence testing is not covered when used:
- for academic or vocational placement or assessment,
- to evaluate non-covered disorders (for example, learning disorders), or
- to assess intelligence without the need to diagnose or plan treatment for a covered psychiatric disorder.
Intensive Outpatient Program for Mental Health and/or Substance Use Disorder
An intensive outpatient program (IOP) for mental health or substance use disorder is a covered benefit for care that is medically and psychologically necessary and appropriate. An IOP typically consists of six to nine or more hours per week of services that include an assessment, treatment and rehabilitation for individuals requiring a lower level of care than a partial hospitalization program (PHP), inpatient/residential substance use disorder rehabilitation facility (SUDRF) care, residential treatment center (RTC) care, or acute inpatient psychiatric or substance use disorder hospitalization.
IOPs may continue to be rendered via telemedicine when medically necessary or appropriate and within the scope of the provider’s license. These services are subject to daily limits per TRICARE policy.
Note: The Drug Enforcement Administration will allow for the prescription of controlled medications through telemedicine through Nov. 11, 2023, or through Nov. 11, 2024, if the practitioner-patient telemedicine relationship was established on or before Nov. 11, 2023.
An approval from Health Net Federal Services, LLC (HNFS) is required for all beneficiaries. The beneficiary’s primary care manager (PCM) or mental health care specialist can use our Inpatient TRICARE Service Request Notification form to submit the request. Active duty service members require a referral from their PCM or local military hospital or clinic before we can authorize IOP services.