Abortions Accreditation Adjunctive Dental Care Allergy Testing And Treatment Ambulance Services
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1 A Abortions Accreditation Adjunctive Dental Care Allergy Testing And Treatment Ambulance Services Ambulatory Surgery Ancillary Inpatient Mental Health Services Anesthesia Administered By Operating Surgeon Antepartum Services Assistant Surgeons Attention-Deficit/Hyperactivity Disorder Audiology Services Auditory System C-6, April 17, 2003
2 B Biofeedback Birthing Centers Accreditation Certification Process Birthing Centers Bone Density Studies Bone Density Studies Bone Density Studies Breast Reconstruction As A Result Of A Congenital Anomaly C-7, May 16, 2003
3 C Cardiac Rehabilitation Cardiovascular System Category II Codes - Performance Measurement Appendix A. Category III Codes 3 1.1A. Central Nervous System Stimulation Certification Of Organ Transplant Centers Certified Clinical Psychologist Clinical Social Worker Marriage And Family Therapist A Certification Process Mental Health Counselors C. Nurse Midwife Pastoral Counselors B. Physician Assistant Psychiatric Nurse Specialist Cesarean Sections Chelation Therapy Chest X-Rays Chiropractic Manipulative Treatment Clinical Psychologist Clinical Social Worker Cochlear Implantation Collagen Implantation For Incontinence Collateral Visits Combined Heart-Kidney Transplantation 3 1.6J. Combined Liver-Kidney Transplantation 3 1.6E. Combined Small Intestine-Liver (SI/L) Transplantation 3 1.6D. 3 C-22, April 30, 2004
4 C (Continued) Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment Computerized Axial Tomography (CAT) Computerized Tomography (CT) Consultations Continued Health Care Benefit Program (CHCBP) Continued Health Care Benefit Program (CHCBP) Continuous Exophageal ph Monitoring (CAEpHM) Corporate Services Provider Class Application Form 10 Addendum E. Corporate Services Provider Class Cosmetic, Reconstructive And Plastic Surgery General Guidelines Court-Ordered Care Custodial Care Prior To December 28, Transitional Policy (CCTP) A. 4 C-7, May 16, 2003
5 D DD 1251 (Sample) , Enc 1. Delivery Of Health Care At Military Treatment Facilities (MTFs) , Enc 2. Department Of Defense Cancer Prevention And Treatment Clinical Trials Demonstration Department Of Veterans Affairs And Department Of Defense Health Care Resources Sharing Dermatological Procedures - General Diabetes Outpatient Self-Management Training Services Diagnostic Genetic Testing Diagnostic Mammography Diagnostic Radiology (Diagnostic Imaging) Diagnostic Ultrasound Digestive System Donor Costs 3 1.6L. Durable Medical Equipment, Basic Program C-7, May 16, 2003
6 E Eating Disorders Programs Echocardiogram For Dental And Invasive Procedures Electric-Powered, Cart-Type Vehicles Electronystagmography Eligibility Requirements For TRICARE Beneficiaries Emergency Department (ED) Services Employer-Operated Medical Facilities Endocrine System Exclusions Eye And Ocular Adnexa C-7, May 16, 2003
7 F Family Planning Family Therapy Female Genital System Fetal Surgery Freestanding Ambulatory Surgery Center Functional Cortical Mapping C-6, April 17, 2003
8 G Gastroenterology GDC - Endovascular Coiling For Unruptured Intracranial Aneurysms General Surgery 3 1.2A. Genetic Diagnostic Testing Genetic Testing Gynecomastia C-7, May 16, 2003
9 H Health And Behavior Assessment/Intervention 1 3.1A. Health Care Finders Hearing Aid Services Heart Transplantation 3 1.6A. Heart-Lung Transplantation 3 1.6B. Hemic And Lymphatic Systems High Dose Chemotherapy Home Health Care and Medicare Eligibles Home Services Hospital Care Hyperbaric Oxygen Therapy Hyperthermia For Treatment Of Cancer Hypnotherapy C-17, October 23, 2003
10 I Immunization Injections Infantile Apnea Cardiorespiratory Monitor Inpatient Concurrent Care Institutional Provider, Individual Provider, And Other Non-Institutional Provider Participation Integumentary System Intersex Surgery Intracoronary Stents C-3, January 28, 2003
11 J Joint Health Benefits Delivery Program
12 K Kidney Transplantation 3 1.6F. 12
13 L Laparoscopic Surgical Procedures Laser Surgery Lead Agent Requirements Learning Disorders Lenses (Intraocular Or Contact) And Eye Glasses Limit On Acute Inpatient Mental Health Care Effective October 1, A. Limit On Residential Treatment Center (RTC) Care Effective October 1, B. Liquid Protein Diets Liver Transplantation 3 1.6C. Lung Transplantation 3 1.6B. Lymphocyte Or Paternal Leukocyte Immunotherapy C-6, April 17, 2003
14 M Magnetic Resonance Angiography (MRA) Magnetic Resonance Imaging (MRI) Male Genital System Marriage And Family Therapists A. Marriage And Family Therapist Maternity Care Mediastinum And Diaphragm Medical Photography Medical Supplies And Dressings (Consumables) Medicare Subvention Demonstration Project (The TRICARE Senior Prime Program) Memorandum Of Understanding Between The Department Of Veterans Affairs And The Department Of Defense , Enc 1. Mental Health Counselors C. Mental Health Wraparound Demonstration Meretek UBT Breath Test With Pranactin Diagnostic Drug Mucus Clearance Devices Multivisceral Transplantation 3 1.6D. Musculoskeletal System C-7, May 16, 2003
15 N National Mail Order Pharmacy Program 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, Cerebrovascular Arterial Studies Nuclear Medicine Nurse Anesthetists Nurse Midwife Nursing Home Visits Nutritional Therapy C-17, OCtober 23, 2003
16 O Obstructive Sleep Apnea Syndrome (OSAS) Occupational Therapy Office Visits With Surgery (TRICARE Claimcheck) Oral Surgery Orthopedic Braces And Appliances, Shoes Orthotics Osteopathic Manipulative Therapy Other Provider Certification Outpatient Observation Stays Oxygen And Oxygen Supplies
17 P Pancreas-After-Kidney Transplantation 3 1.6G. Pancreas-Transplant-Alone 3 1.6G. Papanicolaou (PAP) Tests Partial Hospitalization Programs (PHPs) Standards 10 Addendum B. Participation Agreement Certified Marriage And Family Therapists 10 Addendum C. Freestanding Or Institution-Affiliated Birthing Center Maternity Care Services 10 Addendum D Partial Hospitalization Program Services 10 Addendum A Psychiatric Partial Hospitalization Program 10 Addendum A Requirements Pastoral Counselors B. Patient Transport Percutaneous Transluminal Coronary Angioplasty Pharmacy Photodynamic Therapy And Photochemotherapy (PUVA) Photopheresis Physical Medicine/Therapy Physician Assistant Physician Referral And Supervision Physician-Assisted Suicide Podiatry Portable X-Ray Services Positron Emission Tomography (PET) Postmastectomy Reconstructive Breast Surgery C-12, September 2, 2003
18 P (Continued) Preauthorization Requirements For Acute Hospital Psychiatric Care Effective October 1, C. Residential Treatment Center Care Effective October 1, D. Substance Use Disorder Detoxification And Rehabilitation E. Primary Care Managers Prime - Enrollment Prime And Status Changes Program For Persons With Disabilities (PFPWD) Adjunct Services Benefit Authorization Claims Concurrent Use With The Basic Program Cost-Share Liability Diagnostic Services Durable Equipment Eligibility General Eligibility Qualifying Condition Mental Retardation Serious Physical Disability General Institutional Care Benefit Providers Public Facility Use Certification Special Education Benefit Training Benefit Transportation Treatment Benefit Prophylactic Mastectomy Prophylactic Oophorectomy Prosthesis Replacement Prosthetic Devices Provider Standards For Potentially HIV Infectious Blood And Blood Products Psychiatric Nurse Specialist C-12, September 2, 2003
19 P (Continued) Psychiatric Partial Hospitalization Program Certification Process Certification Standards Preauthorization And Day Limits F. Standards 10 Addendum B. Psychological Testing Psychosurgery Psychotherapy Psychotropic Pharmacologic Management Pulmonary Services C-12, September 2, 2003
20 Q Qualified Accreditation Organization C-6, April 17, 2003
21 R Radiation Oncology Radiation TherapyBrachytherapy Radiofrequency Catheter Ablation Radionuclide Imaging Procedure Rare Diseases Reduction Mammoplasty For Macromastia Rehabilitation - General Request For Contractor Customization Of TRICARE Claimcheck , Enc 1. Requirements For Food And Drug Administration Approval For Medical Devices Resource Sharing And Resource Support Respiratory System Routine Physical Examinations C-7, May 16, 2003
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 3 1.6G. Single Photon Emission Computed Tomography (SPECT) Skilled Nursing Facility (SNF) Visits Small Intestine (SI) Transplantation 3 1.6D. Sonicguide And Other Such Devices Special Authorization Requirements Special Otorhinolaryngologic Services Specialized Treatment Services (STS) Program Speech Services Standby Charges State Licensure And Certification Stem Cell Transplantation Stereotactic Implantation Of Depth Electrodes Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson s Disease Thalamotomy Stereotactic Radiosurgery/Radiotherapy C-17, October 23, 2003
23 S (Continued) Substance Use Disorder Rehabilitation Facilities Certification Process Substance Use Disorders Surgery For Morbid Obesity Surgical Pathology Surrogate Arrangements Coverage C-17, October 23, 2003
24 T Tap Water Iontophoresis Devices Telehealth Originating Site Facility Fee A. Telemedicine/Telehealth Temporal Lobectomy Therapeutic Apheresis Transfusion Services For Whole Blood, Blood Components And Blood Derivatives Transitional Assistance Management Program (TAMP) Transjugular Intrahepatic Portosystemic Shunt (TIPS) Transplant Combined Liver-Kidney (CLKT) 3 1.6E. Combined Small Intestine-Liver (SI/L) 3 1.6D. Donor Costs 3 1.6L. Heart 3 1.6A. Heart-Kidney 3 1.6J. Heart-Lung 3 1.6B. Kidney 3 1.6F. Liver 3 1.6C. Lung 3 1.6B. Multivesceral 3 1.6D. Pancreas-After-Kidney (PAK) 3 1.6G. Pancreas-Transplant-Alone (PTA) 3 1.6G. Simultaneous Pancreas-Kidney (SPK) 3 1.6G. Small Intestine (SI) 3 1.6D. Stem Cell Treatment Of Mental Disorders TRICARE Claimcheck TRICARE For Life TRICARE Overseas Program (TOP) Costs And Uniform HMO Benefits Figures Foreign Claims For Dates Of Service On Or After October 1, Health Care Finders (HCF) C-12, September 2, 2003
25 T (Continued) TRICARE Overseas Program (TOP) (Continued) Overseas Area Director Requirements Overseas Partnership Agreements Definitions , Enc 2. Memorandum Of Understanding , Enc 3. Memorandum Of Understanding , Enc 4. Overseas Partnership Agreements Overview Point Of Contact (POC) Program Prime Catastrophic Loss Protection Clinical Preventive Services Enrollment Point Of Service Option Primary Care Managers (PCM) Prime And Status Changes Sample Of Overseas Area Director TOP Preferred Provider Network Agreements , Enc 1. TRICARE Prime - Clinical Preventive Services A. TRICARE Senior Pharmacy Program TRICARE Standard - Clinical Preventive Services C-12, September 2, 2003
26 U Ultrasound Unauthorized Institution, Related Professional Services Unauthorized Provider, Emergency Services Unproven Devices, Medical Treatment, And Procedures Urgent Care Urinary System C-7, May 16, 2003
27 V Veterans Affairs Health Care Facilities C-6, April 17, 2003
28 W Well-Child Care Wigs Or Hairpiece C-6, April 17, 2003
INDEX CHAPTER SECTION
A Abortions 4 18.3. Accreditation 11 3.3. Adjunctive Dental Care 8 13.1. Aeromedical Evacuation Services 12 10.4. Allergy Testing And Treatment 7 14.1. Ambulance Service 8 1.1. In Overseas Locations For
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
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
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