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1 A Abortions Accreditation Adjunctive Dental Care Aeromedical Evacuation Services Allergy Testing And Treatment Ambulance Service In Overseas Locations For TRICARE Prime-Enrolled Active Duty Family Members (ADFMs) And Related Services To Other Beneficiaries Ambulatory Surgery Ancillary Inpatient Mental Health Services Anesthesia Dental Anesthesiologist Assistant A. Antepartum Services Anticoagulant Management Applied Behavioral Analysis (ABA) Assistant Surgeons Attention-Deficit/Hyperactivity Disorder Audiology Services Auditory System Augmentative Communication Devices (ACD) C-163, August 10, 2012
2 B Biofeedback Birthing Centers Accreditation Certification Process Bone Density Studies Botulinum Toxin Injections Brachytherapy Brachytherapy/Radiation Therapy Breast Pumps Breast Reconstruction As A Result Of A Congenital Anomaly C-170, November 5, 2012
3 C Cancer Clinical Trials Cardiac Rehabilitation Cardiovascular System Cardiovascular Therapeutic Services Category II Codes - Performance Measurement Category III Codes Central Nervous System Assessments/Tests Certification Of Organ Transplant Centers Certified Anesthesiologist Assistant A. Clinical Psychologist Clinical Social Worker Marriage And Family Therapist Certification Process Marriage And Family Therapist Mental Health Counselor Nurse Anesthetist Nurse Midwife Pastoral Counselor Physician Assistant Psychiatric Nurse Specialist Cesarean Sections Chelation Therapy Chemotherapy Administration Chest X-Rays Chiropractic Manipulative Treatment Chronic Fatigue Syndrome (CFS) C-77, April 18, 2008
4 C (Continued) Clinical Preventive Services TRICARE Prime TRICARE Standard Clinical Psychologist Clinical Social Worker Cochlear Implantation Cold Therapy Devices For Home Use Collateral Visits Combined Heart-Kidney Transplantation (CHKT) Combined Liver-Kidney Transplantation (CLKT) Combined Small Intestine-Liver (SI/L) Transplantation Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment Computerized Axial Tomography (CAT) Computerized Tomography (CT) Conscious Sedation Consultations Continued Health Care Benefit Program (CHCBP) Continuous Glucose Monitoring System (NMES) Devices Continuous Passive Motion (CPM) Devices Corporate Services Provider Application Form 11 Addendum D. Participation Agreement Requirements Qualified Accreditation Organization Cosmetic, Reconstructive And Plastic Surgery General Guidelines C-113, December 15, 2009
5 C (Continued) Court-Ordered Care CT Scans Custodial Care Transitional Policy (CCTP) C-97, June 11, 2009
6 D DD 1251 (Sample) Delivery Of Health Care At Military Treatment Facilities (MTFs) Dental Anesthesia And Institutional Benefit Department Of Veterans Affairs And Department Of Defense Health Care Resources Sharing Dermatological Procedures - General Dermoscopy Diabetes Self-Management Training (DSMT) Services Diagnostic Genetic Testing Diagnostic Mammography Diagnostic Radiology (Diagnostic Imaging) Diagnostic Sleep Studies Diagnostic Ultrasound Dialysis Dietitian, Registered Digestive System Donor Costs Durable Medical Equipment C-140, May 25, 2011
7 E Early Eligibility Benefits For Reserve And National Guard (NG) Eating Disorders Programs Echocardiogram For Dental And Invasive Procedures Education And Training For Patient Self Management Electrical Stimulation Of Bone Electronystagmography Eligibility Requirements For TRICARE Beneficiaries Emergency Department (ED) Services Employer-Operated Medical Facilities Employer-Sponsored Group Health Plans (GHPs) Endocrine System Enrollment - Prime Exclusions Extended Care Health Option (ECHO) Benefit Authorization Claims Cost-Share Liability Diagnostic Services Durable Equipment ECHO Home Health Care (EHHC) Eligibility General Qualifying Condition Mental Retardation Other Serious Physical Disability General Institutional Care Other ECHO Benefits Providers Public Facility Use Certification C-171, November 26, 2012
8 E (Continued) Extended Care Health Option (ECHO) (Continued) Registration Respite Care Special Education And Other Educational Services Training Transportation Treatment External Infusion Pump (EIP) Eye And Ocular Adnexa Eye Movement Desensitization and Reprocessing (EMDR) C-171, November 26, 2012
9 F Family Planning Family Therapy Female Genital System Fetal Surgery Forensic Examinations Following Sexual Assault or Domestic Violence Freestanding Ambulatory Surgery Center Psychiatric PHPs Certification Process Standards 11 Addendum A. 9 C-116, January 12, 2010
10 G Gastroenterology General Surgery 4 2.1A. Genetic Diagnostic Testing Genetic Testing Gynecomastia C-75, April 10, 2008
11 H Health And Behavior Assessment/Intervention Healthcare Common Procedure Coding System (HCPCS) "C" And "S" Codes Hearing Aid Services Hearing Aid Services Hearing Aids Heart Transplantation Heart-Kidney Transplantation Heart-Lung Transplantation Hemic And Lymphatic Systems High Dose Chemotherapy And Stem Cell Transplantation Home Infusion Therapy Home Prothrombin Time (PT) International Normalized Ratio (INR) Monitor Home Sleep Studies Home Uterine Activity Monitoring (HUAM) Hospital Care Hyperbaric Oxygen Therapy Hyperthermia For Treatment Of Cancer C-146, September 7, 2011
12 I Implantable Infusion Pump (IIP) Individual Case Management Program For Persons With Extraordinary Conditions (ICMP-PEC) Infantile Apnea Cardiorespiratory Monitor Injections And Infusions Hydration, Therapeutic, Prophylactic, and Diagnostic Inpatient Concurrent Care Institutional Provider, Individual Provider, And Other Non-Institutional Provider Participation Integumentary System Intersex Surgery Intracoronary Stents C-75, April 10, 2008
13 K Kidney Transplantation C-75, April 10, 2008
14 L Laser Surgery Learning Disorders Lenses (Intraocular Or Contact) And Eye Glasses Limit On Acute Inpatient Mental Health Care Limit On Residential Treatment Center (RTC) Care Liquid Protein Diets Liver Cancer Liver Transplantation Living Donor Liver Transplantation (LDLT) Lung Transplantation Lung Volume Reduction Surgery (LVRS) Lymphedema C-98, June 16, 2009
15 M Magnetic Resonance Angiography (MRA) Magnetic Resonance Imaging (MRI) Male Genital System Marriage And Family Therapist Certification Process Maternity Care Mediastinum And Diaphragm Medical Devices Medical Photography Medical Supplies And Dressings (Consumables) Memorandum Of Understanding Between The Department Of Veterans Affairs And The Department Of Defense Mental Health Counselor Moderate (Conscious) Sedation Mucus Clearance Devices Multivisceral Transplantation Musculoskeletal System C-75, April 10, 2008
16 N Negative Pressure Wound Therapy (NPWT) Neonatal And Pediatric Critical Care Services Nervous System Neurology And Neuromuscular Services Neuromuscular Electrical Stimulation (NMES) Devices Nonavailability Statement (DD Form 1251) For Inpatient Care Non-Invasive Vascular Diagnostic Studies Nuclear Medicine Nurse Anesthetist Nurse Midwife Nursing Facility Visits Nutritional Therapy Nutritionist C-140, May 25, 2011
17 O Occupational Therapy Office Visits With Surgery Ophthalmological Services Oral Surgery Orthotics Osteopathic Manipulative Therapy Other Provider Certification Outpatient Observation Stays Outside The 50 United States And The District Of Columbia Locality-Based Reimbursement Rate Waiver Oxygen And Oxygen Supplies C-75, April 10, 2008
18 P Pancreas-After-Kidney Transplantation (PAK) Pancreas-Transplant-Alone (PTA) Papanicolaou (PAP) Tests Partial Hospitalization Programs (PHPs) Certification Process Certification Standards Preauthorization And Day Limits Standards 11 Addendum A. Participation Agreement Certified Marriage And Family Therapist 11 Addendum B. Corporate Services Provider (Sample) Corporate Services Provider Requirements Freestanding Or Institution-Affiliated Birthing Center Maternity Care Services 11 Addendum C. Pastoral Counselor Pathology And Laboratory - General Patient Transport Pharmacy Benefits Program Phase I, Phase II, And Phase III Cancer Clinical Trials Photopheresis Physical Medicine/Therapy Physician Assistant Physician Referral And Supervision Physician Standby Charges Physician-Assisted Suicide Podiatry Portable X-Ray Services C-137, April 12, 2011
19 P (Continued) Positron Emission Tomography (PET) Postmastectomy Reconstructive Breast Surgery Preauthorization Requirements For Acute Hospital Psychiatric Care Residential Treatment Center Care Substance Use Disorder Detoxification And Rehabilitation Primary Care Managers Prime And Status Changes Prime Enrollment Prophylactic Mastectomy, Prophylactic Oophorectomy, And Prophylactic Hysterectomy Prosthetic Devices And Supplies Cranial Prosthesis Provider Standards For Potentially HIV Infectious Blood And Blood Products Providers - General Psychiatric Hospitals Accreditation Pending JC Accreditation, OCHAMPUS Form Psychiatric Nurse Specialist Psychiatric Partial Hospitalization Program Certification Process Certification Standards Preauthorization And Day Limits Standards 11 Addendum A. Psychological Testing Psychotherapy Psychotropic Pharmacologic Management Pulmonary Services C-75, April 10, 2008
20 P (Continued) Pulsed Irrigation Evacuation (PIE) C-75, April 10, 2008
21 R Radiation Oncology Radiation Therapy Radiofrequency Ablation (RFA) Radiologic Guidance Rare Diseases Reduction Mammoplasty For Macromastia Regional Director Requirements Registered Dietitian Rehabilitation - General Requirements For Documentation Of Treatment In Medical Records Residential Treatment Center (RTC) Care Limitations Preauthorization Requirements Resource Sharing Respiratory System Routine Physical Examinations C-170, November 5, 2012
22 S Salivary Estriol Test Sensory Evoked Potentials (SEP) Services Rendered By Employees Of Authorized Independent Professional Providers Sexual Dysfunctions, Paraphilias and Gender Identity Disorders Silicone Or Saline Breast Implant Removal Simultaneous Pancreas-Kidney Transplantation (SPK) Single Photon Emission Computed Tomography (SPECT) Small Intestine (SI) Transplantation Small Intestine-Liver (SI/L) Transplantation Smoking Cessation Counseling Special Authorization Requirements Special Education And Other Educational Services Special Otorhinolaryngologic Services Speech Services State Licensure And Certification Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson s Disease Thalamotomy Substance Use Disorders Rehabilitation Facilities (SUDRFs) Certification Process Preauthorization Requirements Surgery For Morbid Obesity Survivor Status C-161, July 26, 2012
23 T Telemental Health (TMH)/Telemedicine Therapeutic Apheresis Therapeutic Shoes For Diabetics Thermography Transcranial Magnetic Stimulation (TMS) Transfusion Services For Whole Blood, Blood Components And Blood Derivatives Transitional Assistance Management Program (TAMP) Transitional Survivor Status Transjugular Intrahepatic Portosystemic Shunt (TIPS) Transplant Combined Heart-Kidney (CHKT) Combined Liver-Kidney (CLKT) Combined Small Intestine-Liver (SI/L) Donor Costs Heart Heart-Lung Kidney Liver Living Donor Liver (LDLT) Lung Multivisceral Pancreas-After-Kidney (PAK) Pancreas-Transplant-Alone (PTA) Pancreatic Islet Cell Simultaneous Pancreas-Kidney (SPK) Small Intestine (SI) Treatment Of Mental Disorders TRICARE Certified Mental Health Counselor (TCMHC) TRICARE For Life (TFL) C-156, May 3, 2012
24 T (Continued) TRICARE Overseas Program (TOP) Audits, Inspections, Reports, And Plans Authorization Requirements Benefits And Beneficiary Payments Catastrophic Loss Protection (Prime) Clinical Preventive Services (Prime/Standard) Continued Health Care Benefit Program (CHCBP) Overseas Eligibility Requirements Enrollment (Prime/TRICARE Plus) Extended Care Health Option (ECHO) - General Figures Foreign Claims For Dates Of Service On Or After October 1, Health Care Finders (HCF) Host Nation Provider Introduction Managed Care Support Contractor (MCSC) Responsibilities For Claims Processing Partnership Program (Reserved) Payment Policy Point Of Contact (POC) Program Point Of Service (POS) Option (Prime) Primary Care Managers (PCM) (Prime) Prime And Status Changes Provision Of Respite Care For The Benefit Of Seriously Ill Or Injured Active Duty Members Sample Of Overseas Regional Director TOP Preferred Provider Network Agreements , Enc 1. Transitional Assistance Management Program (TAMP) Overseas TRICARE Area Office (TAO) Director Requirements TRICARE Reserve And National Guard Family Member Benefits C-156, May 3, 2012
25 U-Z Ultrasound Unauthorized Institution, Related Professional Services Unauthorized Provider, Emergency Services Unfortunate Sequelae From Noncovered Services in a Military Treatment Facility (MTF) Unproven Devices, Medical Treatment, And Procedures Urinary System Veterans Affairs Health Care Facilities Waiver Of Liability Initial Denial Determinations MCS Contractor Reconsideration Determinations NQMC Reconsideration Determinations Well-Child Care Wigs/Cranial Prosthesis Or Hairpiece C-160, June 18, 2012
26
Index. TRICARE Policy Manual M, February 1, C-106, February 3, 2014
A Chap Sec/Add Abortions 4 18.3 Accreditation 11 3.3 Acronyms And Abbreviations Appendix A Adjunctive Dental Care 8 13.1 Allergy Testing And Treatment 7 14.1 Ambulance Service 8 1.1 Ambulatory Surgery
Index. TRICARE Policy Manual M, April 1, Index. Revision:
TRICARE Policy Manual 6010.60-M, April 1, 2015 Revision: A CHAP SEC/ADD Abortions 4 18.3 Accreditation 11 3.3 Adjunctive Dental Care 8 13.1 Allergy Testing And Treatment 7 14.1 Ambulance Service 8 1.1
Index. TRICARE Policy Manual M, April 1, 2015 Index. Revision: C-8, August 28, 2017
Revision: A CHAP SEC/ADD Abortions 4 18.3 Accreditation 11 3.3 Acute Hospital Psychiatric Care: Preauthorization, Concurrent Review, and Payment Responsibility 7 3.1 Adjunctive Dental Care 8 13.1 Advance
Abortions Accreditation Adjunctive Dental Care Allergy Testing And Treatment Ambulance Services
A Abortions 3 13.3. Accreditation 10 2.3. Adjunctive Dental Care 7 26.1. Allergy Testing And Treatment 1 21.1. Ambulance Services 7 2.1. Ambulatory Surgery 7 9.1. Ancillary Inpatient Mental Health Services
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