What are the TRICARE benefit limits for behavioral health care?
• Behavioral health evaluation and therapy benefits are limited to two (2) routine therapy sessions per week; more frequent visits require additional authorization. • Substance use disorder benefits are limited to 60 group therapy sessions and 15 family therapy sessions per benefit period. Individual outpatient therapy is not a covered benefit for beneficiaries with a primary diagnosis of substance use disorder. The benefit period begins with the first day of a treatment episode and ends 365 days later, regardless of the total services actually used within the year. Services must be rendered by institutional providers and always require prior authorization. • Psychological testing is generally limited to six (6) hours per year and requires a medical necessity review and prior authorization. • Behavioral health benefits are limited to 30 days per fiscal year or per admission for acute inpatient care for ages 19 and older; and 45 days per fiscal year or per admission for acute inpatient
