Update on Temporary Program Changes in Response to COVID-19 Pandemic
Wednesday, August 31, 2022
In 2020, in response to the COVID-19 pandemic, the Department of Defense (DOD) implemented many temporary changes to the TRICARE benefit, ranging from increased reimbursement for COVID-19 inpatient stays to covered audio-only office visits to copayment/cost-share waivers for covered telehealth services. The DOD has since published updates to the TRICARE manuals that terminate, modify or keep in place some of the temporary changes. Regional contractors will be implementing these changes on Sept. 6, 2022.
Telemedicine copays reinstated
TRICARE has reinstated copayments, cost-shares and deductibles for covered telehealth (telemedicine) services rendered on or after July 1, 2022. We will be working with our telehealth partners to share this update. Referral requirements for telehealth remain the same as in-person visits. View our telehealth billing tips.
Audio-only office visits now a permanent benefit
Effective July 1, 2022, TRICARE has made permanent the previously temporary benefit that allowed for medically necessary telephonic office visits. TRICARE will cover medically necessary audio-only telehealth between providers and beneficiaries and telephonic provider-to-provider consults. Telephone calls of an administrative nature remain excluded (for example: appointment scheduling, prescription refills, obtaining test results).
Temporary hospitals and freestanding ambulatory surgery centers (FASCs) remain TRICARE-authorized
Hospitals and FASCs, or other entities, enrolled with Medicare as a hospital on a temporary basis will continue to be considered TRICARE-authorized facilities through the expiration of Medicare’s Hospital Without Walls initiative.
Qualifying hospital stay for skilled nursing facility (SNF) admissions still waived
For SNF admission dates on or after March 1, 2020, TRICARE will continue to waive the requirement for a qualifying hospital stay of three consecutive days or more prior to a SNF admission through the end of the public health emergency period.
Temporary payment adjustments remain on inpatient claims for those diagnosed with coronavirus or COVID-19
Inpatient claims reimbursement for coronavirus/COVID-19 admissions on or after Jan. 27, 2020, will continue to reflect a 20% increase to the diagnosis-related group (DRG) weighted rate through the end of the public health emergency period.
Long-term care hospitals (LTCHs) to continue to be reimbursed at higher rate
Per the Coronavirus Aid, Relief, and Economic Security (CARES) Act, LTCH admissions on or after Jan. 27, 2020, will continue to be reimbursed at the LTCH prospective payment system (PPS) standard federal rate instead of the lower site-neutral payment rate through the end of the public health emergency period.
Please continue to visit our Benefits A–Z pages, our COVID-19 resources page, and TRICARE’s www.tricare.mil/coronavirus page for updates.