Temporary Expansion of Telemedicine Benefit: Audio-Only Services, Copayment Waiver, State Licensing Update
Thursday, May 21, 2020
Through an interim final ruling, the Defense Health Agency has again temporarily expanded TRICARE’s telemedicine benefit in response to COVID-19. These changes are effective May 12, 2020, and remain valid through the expiration of the national emergency for the COVID-19 outbreak. As we work to implement these changes, please note that some claims may be held for processing. For the latest TRICARE benefit updates and additional details on telemedicine, visit our COVID-19 resource page and www.health.mil/coronavirus.
Audio-only services allowed
TRICARE will now allow for audio-only telehealth for medically or psychologically necessary office visits. Audio-only telehealth can be for provider-to-patient care or for clinical consultations between providers that is specific to a patient’s care. TRICARE plan rules still apply. For example, TRICARE Prime beneficiaries must have a referral from their primary care manager (PCM) for specialty care visits, when required. 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. Administrative services such as making appointments or verifying prescriptions are not separately reimbursable.
Please continue to use appropriate telehealth modifiers when submitting claims. Find billing tips on our Telemedicine Billing Tips page.
Telemedicine copays waived
TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12. This waiver applies to all 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.
TRICARE-authorized providers who hold a valid state license may render telemedicine in states where they are not licensed, as long as they comply with state guidelines for waivers or temporary licenses required in response to COVID-19. Providers must practice within the scope of their licensure (including temporary licenses) and maintain copies for claims auditing purposes.