TRICARE Policy Manual 6010.57-M


The TRICARE Policy Manual (TPM) is incorporated by reference in the Managed Care Support Services (MCSS) contracts and is the principal vehicle for operating guidelines and instructions. The TPM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TPM, in conjunction with the February 2008 TRICARE Reimbursement Manual, provides guidance, policy interpretation and decisions implementing TRICARE, including those policies and procedures applicable to the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The TPM contains operational policy necessary to implement Title 32 to the Code of Federal Regulations Part 199 (32 CFR 199). This manual augments the 32 CFR 199 and must be used in conjunction for complete policy information.
NOTE
The MCS Manuals for contracts prior to 06/26/2008 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each manuals' web page. Select the desired manual below, then proceed to the "Superseded" manual(s) that exist below the "Current" manual. For the ADP Manual, select the TSM Manual.

February 1, 2008 edition

This manual is valid for contracts awarded on or after June 27, 2008 for the North, South, and West Regions along with TQMC, CARS, TOP, and TPharm. The manuals will apply to the TDEFIC contract upon direction of the Contracting Officer.
The February 1, 2008 edition of the TRICARE Policy Manual (TPM), 6010.57-M, is available online.
All future changes will be published to this edition.
Last Updated: August 1, 2017
Most Recent Change Number: Change 186

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Page Count: 1,120
Summary of Changes: See the Change Transmittal. This change is published in conjunction with Feb 2008 TRM Change 140.


August 1, 2002 edition - Superseded

This manual is valid for contracts awarded on or after May 1, 2003 through June 26, 2008 for the North, South, and West Regions along with TDEFIC, NQMC, CARS, Retail, and TMOP.
The August 1, 2002 edition of the TRICARE Policy Manual (TPM), 6010.54-M, is available online. This edition supersedes the June 25, 1999 edition. All changes to the June 25, 1999 edition (through Change 22 dated April 30, 2004) have been incorporated.
No future changes will be published to this edition.
Last Updated: April 3, 2013
Most Recent Change Number: Change 175

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Page Count: 1,144
Summary of Changes: See the Change Transmittal. This change is published in conjunction with Aug 2002 TRM Change 159 and Aug 2002 TSM Change 102.


March 15, 2002 edition - Superseded

This manual is valid for contracts awarded on or before April 30, 2003.
The March 15, 2002 edition of the TRICARE Policy Manual (POL), 6010.47-M, is available online. This edition reissued the TRICARE Policy Manual and supersedes the June 25, 1999 edition. All changes to the June 25, 1999 edition (through Change 33 dated February 13, 2002) have been incorporated.
No future changes will be published to this edition.
Last Updated: April 30, 2004
Most Recent Change Number: Change 22

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Page Count: 980
Summary of Changes: This change adds 2004 CPT coding changes to the TRICARE Manuals. In addition, included in this change package are the policies which required the updated AMA 2004 CPT copyright statement. This change is published in conjunction with May 1999 ADP Change 50, Mar 2001 OPM Change 38, and Mar 2002 TRM Change 32.


June 25, 1999 edition - Superseded

The June 25, 1999 edition of the TRICARE Policy Manual (POL), 6010.47-M, is available online. This edition reissued the TRICARE Policy Manual and supersedes the December 18, 1998 edition. All changes to the December 18, 1998 edition (through Change 12 dated May 14, 1999) have been incorporated.
This online edition incorporates "Work Simplification" as described in this Notice.
No future changes will be published to this edition.
Last Updated: February 13, 2002
Most Recent Change Number: Change 33

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Page Count: 1,630
Summary of Changes: This change permits the temporary extension of TFL and TSRx benefits for whom a DEERS response of 7ONE is received. This change is published in conjunction with Mar 2001 OPM Change 13.


December 18, 1998 edition - Superseded

The December 18, 1998 edition of the TRICARE/CHAMPUS Policy Manual (POL), 6010.47-M, is available online. This edition reissued the TRICARE/CHAMPUS Policy Manual and supersedes the May 15, 1996 edition. All changes to the May 15, 1996 edition (through Change 35 dated November 4, 1998) have been incorporated.
This online edition includes the following administrative changes: reformatting, editorial changes and deletion of obsolete material.
No future changes will be published to this edition.
Last Updated: May 14, 1999
Most Recent Change Number: Change 12

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Page Count: 0
Summary of Changes: This correction removes the reference to living donor lobar lung transplantation listed in EXCLUSIONS and viral-induced liver disease when evidence of viremia is present which were inadvertently not deleted in Dec 1998 Policy Change 10.


May 15, 1996 edition - Superseded

The May 15, 1996 edition of the TRICARE/CHAMPUS Policy Manual (POL), 6010.47-M, is available online in a limited capacity. The user can only view/save Changes 1 (May 20, 1996) through 35 (November 4, 1998). This edition supersedes the September 1, 1989 edition and incorporates all changes to that manual through Change 105 dated March 1, 1996.
The "Entire Change Package" option indicates that the entire change package was small enough to be contained in one file; however, if it is a large change package the package will be divided into parts. (Example: Part 1: Chap 1 - 3, Part 2: Chap 4 - 6, etc.). Legend for abbreviations used below: Chap = Chapter, Sec = Section, Add = Addendum, Tbl = Table, TOC = Table of Contents, Pgs = Pages.
No future changes will be published to this edition.
Last Updated: November 4, 1998
Most Recent Change Number: Change 35

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Page Count: 0
Summary of Changes: This change provides additional clarifying instructions for the CHAMPUS DRG-based payment system including payment of transfer cases with cost outliers and reimbursement of capital and direct medical education costs, and corrects the footnote for the wage index for MSA 1650. This change also sets forth the payment conditions for corneal tissue used in a corneal transplant that is performed in an ambulatory surgery center, a physician''s office, or on an outpatient basis. The physical therapy policy is being reissued to remove the diapulse criteria that was inadvertently left in a previous change.