last updated May 29, 2020
The Centers for Disease Control and Prevention (CDC) continues to monitor the coronavirus outbreak, now referred to as COVID-19, first identified in Wuhan, Hubei Province, China.
Frequently Asked Questions
Where can I find the latest information on COVID-19?
For the most up-to-date information, visit the CDC’s website.
Where can I find information specific to TRICARE and COVID-19?
In addition to this page, we continue to post articles in the News section of our provider home page. Recent provider education includes:
Find additional details at:
(see also Telemedicine)
Does TRICARE cover telemedicine?
TRICARE covers medically and psychologically necessary telehealth services. TRICARE policy guidelines and exclusions apply.
Are audio-only services covered?
Effective May 12, 2020, TRICARE will temporarily cover audio-only telemedicine services. Audio-only telehealth should not be used for care that normally requires a physical examination or a visual evaluation. Administrative services such as making appointments or verifying prescriptions are not separately reimbursable.
What is the copayment for telemedicine?
TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.
Do I need a separate authorization for telemedicine?
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 care via telemedicine. View current approval guidelines.
Can partial hospitalization program (PHP) or intensive outpatient program (IOP) services be rendered via telemedicine? What about medication assistance treatment (MAT) and opioid treatment programs?
In response to the COVID-19 pandemic, retroactive to March 13, 2020, the Defense Health Agency (DHA) is temporarily allowing for intensive outpatient care (IOP) services to be rendered via telehealth. These services are subject to daily limits per TRICARE policy. Additionally, DHA is temporarily allowing for MAT and opioid treatment programs to be rendered via telemedicine.
Partial hospitalization program (PHP) services via telehealth are not a covered service; however, half-day PHP services are reimbursable as an IOP when authorized and billed as such. Individual provider services such as psychotherapy and medication management that are not provided in conjunction with a PHP may be considered for telemedicine coverage.
What applied behavior analysis services can be rendered via telemedicine?
During the emergency period of March 31–May 31, 2020, the Defense Health Agency has expanded telemedicine options allowed under TRICARE's Autism Care Demonstration. In addition to outcome measures, ABA supervisors and assistant behavior analysts may provide parent/caregiver guidance telehealth. Specific exclusions apply. Providers are responsible for understanding TRICARE's policy revision and how to manage authorizations during this emergency period.
How does state licensing apply to telemedicine?
Effective May 12, 2020, TRICARE expanded its telemedicine policy to allow TRICARE-authorized providers to render services across state lines as long as they comply with interstate policy in the state the beneficiary is receiving care. This temporary change does not replace state authority to regulate licensure, but assures providers who are in compliance with applicable state or federal law that they will be eligible for reimbursement under TRICARE when caring for beneficiaries during the COVID-19 pandemic. Providers must practice within the scope of their licensure (including temporary licenses) and maintain copies for claims auditing purposes.
How is telemedicine billed?
Telemedicine services billed on CMS 1500 professional claims must be billed with the appropriate modifier (GT, GQ or 95) and place of service 02. UB04 claims must contain one of the telemedicine modifiers (GT, GQ or 95). If additional services are rendered after the telemedicine visits ends, providers should not use telemedicine modifiers and indicate the actual place of service (i.e., office) on the claim. For more billing tips, visit our Telemedicine Services page.
Why did my professional claim for telemedicine services pay at a different rate than when I provided the services in person?
We recognize certain telemedicine claims for professional services were reimbursed at a facility CHAMPUS Maximum Allowable Charge (CMAC) rate rather than a non-facility (office) CMAC. We are adjusting certain telemedicine claims that paid at the facility CMAC rate. The adjustment will apply the non-facility CMAC and in some instances may refund the patient copayment. There is no action required on your part. Non-facility professional charges billed with a telemedicine modifier and place of service 02 will be reimbursed based on the non-facility CMAC rate for the location.
Does TRICARE cover COVID-19 testing?
TRICARE covers medically necessary and appropriate diagnostic and antibody (serology) testing. Beneficiaries suspected to have COVID-19 should be tested following Centers for Disease Control and Prevention (CDC) guidelines. COID-19 diagnostic and antibody tests must meet Families First Coronavirus Response Act (FFCRA) criteria. Antibody tests must be rendered to diagnose and/or treat beneficiaries. Please review benefit details on our Benefits A–Z page.
Do I need prior authorization for COVID-19 testing?
There are no authorization requirements specific to COVID-19 testing. You do not need an approval from HNFS for medically necessary testing.
Are there utilization limits for how often a COVID-19 test can be provided?
No. Care must be medically necessary and appropriate.
What copayment or cost-share will my TRICARE patients have?
Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits (to include covered telemedicine) during which tests are ordered or administered. See our Benefits A–Z page for additional clarification.
Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. Find current cost information on our Copayment and Cost-Share pages.
Will a patient who is admitted to the hospital as a result of a COVID-19 infection still have a copayment/cost-share?
Ongoing treatment of a COVID-19 infection is still subject to copayments/cost-shares. While emergency room copayments may be waived, patients admitted to the hospital as a result of a COVID-19 infection would still incur treatment-related copayments/cost-shares, including those for hospital admissions.
What are the CDC recommendations for preventing the spread of COVID-19 and other viral illnesses?
Review CDC guidelines at www.cdc.gov/COVID19 and www.cdc.gov/coronavirus/2019-ncov/faq.html.
Where can I find current guidelines for health care providers?
Review the CDC’s guidance for health care professionals. Be sure to get a detailed travel history for patients who present with flu-like illness.
Why are people so worried about coronavirus?
This is a new virus, and it is creating great concern in the community. There is not a vaccine for this novel virus yet, and we do not have a specific medicine to treat it. An effective vaccine is most likely 12–18 months away. Also, the coronavirus is contagious – similar to the flu. Most people who become infected with the coronavirus have a mild illness or may not even have any symptoms.
What recommendations should I give to patients who are concerned they may have COVID-19 or believe they have been in contact with someone with the virus?
Per the CDC,
- Seek medical advice.
- Call ahead before going to a doctor’s office or emergency room.
- Tell your doctor about recent travel and your symptoms.
- Some providers may offer telemedicine as an alternative to coming into the office. TRICARE covers medically-necessary telemedicine services when all criteria are met. Learn more on our Telemedicine Services page.
- If your primary doctor is not available, TRICARE beneficiaries can go to any TRICARE-authorized urgent care center or if necessary, an emergency department.
- TRICARE beneficiaries who need health advice can contact the Military Health System’s Nurse Advice Line 24/7.
- Avoid contact with others and do not travel while sick.
- Contact your local public health department as soon as practical.
- Learn more at www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html.
What can one do while sick to prevent the spread to others?
The best way to prevent illness from spreading is to avoid exposing others. Stay home except to get medical care, and separate yourself from other people and animals in your home.
For those planning travel to abroad to affected countries:
View the CDC’s current travel notice and FAQs.
For travelers already in affected countries where the virus may be present.
View the CDC’s current travel notice and FAQs.
For travelers returning from areas with the virus.
United States residents who travel to other countries where this outbreak has occurred may be screened upon re-entry to the U.S.
Certain military installations have been selected as potential U.S. quarantine sites.
Source: Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/index.html