Copayments and Cost-Shares TRICARE is waiving copayments and cost-shares for covered audio-only or video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. During this stateside public health emergency, there are no copays or cost-shares for telemedicine care and audio only telemedicine visits are covered. TRICARE policy requires providers to have a license in the state where they practice and where the patient lives, but TRICARE will temporarily reimburse providers for interstate care to patients.
See our Telemedicine Services page for benefit information and approval requirements.
Synchronous Telemedicine Services
Tricare Telehealth Copay 2021
Synchronous telemedicine services involve an interactive, electronic information exchange in at least two directions in the same time period.
Providers must bill using CPT® or HCPCS codes with a GT or 95 modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Payment for Q3014 will not be made when a patient's home is the originating site. The distant site and originating site cannot be billed by the same provider.
For professional claims, use the place of service code (POS) that represents the location from which he/she rendered the telemedicine visit. For example, POS 11 if services are rendered from the provider's office.
- Exception: At this time, applied behavior analysis (ABA) claims continue to require the appropriate telemedicine modifier and POS 02 for all telemedicine claims.
- See FAQs below for information on resubmitting non-facility claims previously submitted with POS 02.
By billing the GT or 95 modifier with a covered telemedicine procedure code, the distant site provider certifies the beneficiary was present at an eligible originating site when the telemedicine service was furnished.
Asynchronous Telemedicine Services
Asynchronous telemedicine services involve storing, forwarding and transmitting medical information on telemedicine encounters in one direction at a time.
Providers must bill using CPT or HCPCS codes with a GQ modifier. For professional claims, use the place of service code (POS) that represents the location from which he/she rendered the telemedicine visit. For example, POS 11 if services are rendered from the provider's office. However, at this time, ABA claims continue to require the appropriate telemedicine modifier and POS 02 for all telemedicine claims.
Note: When submitting claims for telemedicine services, the originating site provider may indicate 'Signature not required – distance telemedicine site' in the required Patient Signature field.
Coronavirus (COVID-19) Update:
Long drive pe chal hd video song free download. Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate. |
- TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
- TRICARE Young Adult costs are based on the sponsor's status.
- TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit).
- Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.
A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:
- Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
- Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.
TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)
| Service | Active Duty Family Members | Retirees and Their Family Members |
|---|---|---|
| Primary Care Outpatient Office Visits | Group A: $0 Group B: $0 | Group A: $21 Group B: $21 |
Specialty Care Outpatient (this includes physical, occupational | Group A: $0 Group B: $0 | Group A: $31 Group B: $31 |
TRICARE Select (not including TRICARE Young Adult)
| Service | Active Duty Family Members | Retirees and Their Family Members |
|---|---|---|
| Primary Care Outpatient Office Visits | Group A: Network Provider: $22 Group B: Network Provider: $15 | Group A: Network Provider: $30 Group B: Network Provider: $26 |
Specialty Care Outpatient (this includes physical, occupational | Group A: Network Provider: $34 Group B: Network Provider: $26 | Group A: Network Provider: $46 Group B: Network Provider: $42 |
TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)
| Service | TRS | TRR |
|---|---|---|
| Primary Care Outpatient Office Visits | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient (this includes physical, occupational | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |
TRICARE Young Adult (TYA)
Tricare West Telehealth
| Service | TYA Prime | TYA Select | ||
|---|---|---|---|---|
| Active Duty Family Members | Retiree Family Members | Active Duty Family Members | Retiree Family Members | |
| Primary Care Outpatient Office Visits | $0 | $21 | Network Provider: $15 Non-Network Provider: 20% | Network Provider: $26 Non-Network Provider: 25% |
Specialty Care Outpatient Office Visits (this includes physical, | $0 | $31 | Network Provider: $26 Non-Network Provider: 20% | Network Provider: $42 Non-Network Provider: 25% |