Index. TRICARE Policy Manual M, April 1, Index. Revision:
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1 TRICARE Policy Manual M, April 1, 2015 Revision: A CHAP SEC/ADD Abortions Accreditation Adjunctive Dental Care Allergy Testing And Treatment Ambulance Service Ambulatory Surgery Ancillary Inpatient Mental Health Services Anesthesia Dental Anesthesiologist Assistant (AA) Antepartum Services Anticoagulant Management Application Form For Corporate Services Providers 11 D Assistant Surgeons Attention-Deficit/Hyperactivity Disorder Audiology Service Auditory System Augmentative Communication Devices (ACDs) Automated External Defibrillators (AEDs) B CHAP SEC/ADD Biofeedback Birthing Centers Accreditation Certification Process Bone Density Studies Botulinum Toxin Injections Brachytherapy Breast Prostheses Breast Pumps, Breast Pump Supplies, And Breastfeeding Counseling Breast Reconstruction As A Result Of A Congenital Anomaly C CHAP SEC/ADD Cancer Clinical Trials Cardiac Rehabilitation Cardiovascular System Cardiovascular Therapeutic Services Category II Codes - Performance Measurement Category III Codes Central Nervous System (CNS) Assessments/Tests Certification Of Organ Transplant Centers Certified Clinical Social Worker (CSW) Certified Marriage And Family Therapist Certification Process Certified Nurse Midwife (CNM) Certified Physician Assistant Certified Psychiatric Nurse Specialist (CPNS) Cervical Cancer Screening Cesarean Sections Chelation Therapy Chemotherapy Administration Chest X-Rays Chiropractic Manipulative Treatment (CMT) Chronic Care Management (CCM) Services Chronic Fatigue Syndrome (CFS) Clinical Preventive Services TRICARE Prime TRICARE Standard Clinical Psychologist Cochlear Implantation Cold Therapy Devices For Home Use Collateral Visits Combined Heart-Kidney Transplant (CHKT) Combined Liver-Kidney Transplant (CLKT) Combined Small Intestine-Liver (SI/L) Transplant
2 C (CONTINUED) CHAP SEC/ADD E CHAP SEC/ADD Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment Computerized Axial Tomography (CAT) Computerized Tomography (CT) Consultations Continued Health Care Benefit Program (CHCBP) Continuous Glucose Monitoring System (CGMS) Devices Continuous Passive Motion (CPM) Devices Corporate Services Provider Class Cosmetic, Reconstructive And Plastic Surgery - General Guidelines Cost-Share Liability Court-Ordered Care Custodial Care Transitional Policy (CCTP) D CHAP SEC/ADD Dental Anesthesia And Institutional Benefit Department Of Veterans Affairs (DVA) And DoD 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 Drug Testing Durable Medical Equipment (DME) - Basic Program Early Eligibility Benefits For Reserve And National Guard (NG) Eating Disorder Programs Eating Disorder Treatment Echocardiogram For Dental And invasive Procedures Education And Training For Patient Self Management Electrical Stimulation Of Bone Electronystagmography (ENG) Eligibility Requirements For TRICARE Beneficiaries Emergency Department (ED) Services Employer-Operated Medical Facilities Employer-Sponsored Group Health Plans (GHPs) Endocrine System Exclusions Extended Care Health Option (ECHO) Benefit Authorization Benefits - Other Hippotherapy Claims Diagnostic Services Durable Equipment (DE) ECHO Home Health Care (EHHC) Eligibility General Qualifying Condition Mental Retardation Other Serious Physical Disability General Institutional Care Providers Public Facility Use Certification Registration Respite Care Special Education And Other Services Training Transportation Treatment External Infusion Pump (EIP) Eye And Ocular Adnexa Eye Movement Desensitization and Reprocessing (EMDR)
3 F CHAP SEC/ADD Family Planning Family Therapy Female Genital System Fetal Surgery Forensic Examinations Following Sexual Assault or Domestic Violence Freestanding Ambulatory Surgery Center (ASC) Partial Hospitalization Program (PHP) G CHAP SEC/ADD Gastroenterology General Policy And Responsibilities General Surgery Genetic Testing Gynecomastia H CHAP SEC/ADD Health And Behavior Assessment/ Intervention Healthcare Common Procedure Coding System (HCPCS) C And S Codes Hearing Aids And Hearing Aid Services Heart Transplant Heart-Lung Transplant Hemic And Lymphatic Systems High Dose Chemotherapy (HDC) And Stem Cell Transplantation Home Infusion Therapy Home Prothrombin Time (PT) International Normalized Ratio (INR) Monitor Home Sleep Studies Hospital Care Hydration, Therapeutic, Prophylactic, And Diagnostic Injections And Infusions Hyperbaric Oxygen (HBO) Therapy Hyperthermia I CHAP SEC/ADD Implantable Infusion Pump (IIP) Individual Case Management Program For Persons With Extraordinary Conditions (ICMP-PEC) Infantile Apnea Cardiorespiratory Monitor I (CONTINUED) CHAP SEC/ADD Injections And Infusions Inpatient Concurrent Care Institutional Care Institutional Provider, Individual Provider, And Other Non-Institutional Provider Participation Integumentary System Intersex Surgery Intracoronary Stents K CHAP SEC/ADD Kidney Transplant L CHAP SEC/ADD 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 Transplant Living Donor Liver Transplant (LDLT) Lung Transplantation Lung Volume Reduction Surgery (LVRS) Lymphedema M CHAP SEC/ADD Magnetic Resonance Angiography (MRA) Magnetic Resonance Imaging (MRI) Male Genital System Maternity Care Mediastinum And Diaphragm Medical Devices Medical Photography Medical Supplies And Dressings (Consumables) Memorandum Of Understanding (MOU) Between the Department of Veterans Affairs (DVA) and the DoD Mental Health Counselor Moderate (Conscious) Sedation Mucus Clearance Devices Multivisceral Transplant Musculoskeletal System
4 N CHAP SEC/ADD Negative Pressure Wound Therapy (NPWT) Neonatal And Pediatric Critical Care Services Nervous System Neurology And Neuromuscular Services Neuromuscular Electrical Stimulation (NMES) Devices Non-Invasive Vascular Diagnostic Studies Nuclear Medicine Nurse Anesthetist Nurse Midwife Nursing Facility Visits Nutritional Therapy Nutritionist O CHAP SEC/ADD Occupational Therapy Office Visits With Surgery Ophthalmological Services Oral Surgery Orthotics Osteopathic Manipulative Therapy Outpatient Observation Stays Oxygen And Oxygen Supplies P CHAP SEC/ADD Pancreas-After-Kidney (PAK) Transplant Pancreas-Transplantation-Alone (PTA) Papanicolaou (PAP) Tests Participation Agreements Certified Marriage And Family Therapist 11 B Freestanding Or Institution- Affiliated Birthing Center (BC) Maternity Care Services 11 C Freestanding Psychiatric Partial Hospitalization Program (PHP) Services 11 I Requirements Residential Treatment Center (RTC) 11 G Substance Use Disorder Rehabilitation Facility (SUDRF) Services For TRICARE/CHAMPUS Beneficiaries 11 E Pastoral Counselor P (CONTINUED) CHAP SEC/ADD Pathology And Laboratory - General Patient Self Management - Education And Training Patient Transport Pharmacy Benefits Program Phase I, Phase II, And Phase III Cancer Clinical Trials Photopheresis Physical Medicine/Therapy Physician Referral And Supervision Physician Standby Charges Physician-Assisted Suicide Podiatry Portable X-Ray Services Positron Emission Tomography (PET) Post-Mastectomy Reconstructive Breast Surgery Preauthorization Requirements 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 Provider Certification - Other Provider Standards For Potentially Human Immunodeficiency Virus (HIV) Infectious Blood And Blood Products Providers - General Provisional Coverage For Emerging Services And Supplies Psychiatric Hospitals Accreditation Psychiatric Partial Hospitalization Program (PHP) Certification Process Certification Standards Preauthorization And Day Limits Psychological Testing Psychotherapy Psychotropic Pharmacologic Management Public Facility Use Certification Pulmonary Services Pulsed Irrigation Evacuation (PIE)
5 Q CHAP SEC/ADD Qualified Accreditation Organization R CHAP SEC/ADD Radiation Oncology Radiation Therapy Radiologic Guidance Rare Diseases Reduction Mammaplasty For Macromastia Registered Dietitian (RD) Rehabilitation - General Requirements For Documentation Of Treatment In Medical Records Respiratory System Routine Physical Examinations S CHAP SEC/ADD 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 (SPK) Transplant Single Photon Emission Computed Tomography (SPECT) Skilled Nursing Facility (SNF) Visits Small Intestine (SI) Transplant Small Intestine-Liver (SI/L) Transplant Smoking Cessation Counseling Special Authorization Requirements Special Education And Other Services Special Otorhinolaryngologic Services Speech Services Standards Inpatient Rehabilitation And Partial Hospitalization For The Treatment Of Substance Use Disorders 11 F Psychiatric Partial Hospitalization Programs (PHPs) 11 A Residential Treatment Centers (RTCs) Serving Children And Adolescents 11 H State Licensure And Certification State Vaccine Programs (SVPs) As TRICARE-Authorized Providers S (CONTINUED) CHAP SEC/ADD Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson s Disease Stereotactic Radiofrequency Thalamotomy Substance Use Disorder Rehabilitation Facilities (SUDRFs) Certification Process Substance Use Disorders Surgery For Morbid Obesity T CHAP SEC/ADD 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 Care Management Services Transitional Survivor Status And Survivor Status Transjugular Intrahepatic Portosystemic Shunt (TIPS) Transplant Combined Heart-Kidney (CHKT) Combined Liver-Kidney (CLKT) Donor Costs Heart Kidney Liver Living Donor Liver (LDLT) Multivisceral Pancreas-After-Kidney (PAK) Pancreas-Transplant-Alone (PTA) Pancreatic Islet Cell Simultaneous Pancreas-Kidney (SPK) Small Intestine (SI) Small Intestine-Liver (SI/L) Combined Treatment Of Mental Disorders
6 T (CONTINUED) CHAP SEC/ADD Treatment Of Unfortunate Sequelae And/Or Medically Necessary Follow- On Care Subsequent To Auhtorized Noncovered Initial Surgery Or Treatment In A Military Treatment Facility (MTF)/Enhanced Multi-Service Market (emsm) TRICARE Certified Mental Health Counselor (TCMHC) TRICARE For Life (TFL) And Other Medicare-Eligible Beneficiaries TRICARE Overseas Program (TOP) Medical Benefit Variations Outside The 50 United States And The District Of Columbia Locality- Based Reimbursement Rate Waiver TRICARE Reserve And National Guard (NG) Family Member Benefits U CHAP SEC/ADD Ultrasound Unauthorized Institution - Related Professional Services Unauthorized Provider - Emergency Services Unproven Drugs, Devices, Medical Treatments, And Procedures Urinary System V CHAP SEC/ADD Veterans Affairs (VA) Health Care Facilities W CHAP SEC/ADD Waiver Of Liability Well-Child Care Wigs Or Hairpiece END - 6
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
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
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