TRICARE Reimbursement Manual 6010.61-M


Each TRICARE Manual on the web incorporates all changes by the date of publication. Although changes are published, they may not be implemented by the contractor until directed to do so by the Contracting Officer.
The TRICARE Reimbursement Manual (TRM) is incorporated by reference in the Managed Care Support Contracts (MCSCs) and is the primary vehicle for operating guidelines and instructions. The TRM provides a mechanism for keeping the contracts current by clarifying or modifying existing contractual requirements, adding new specifications/requirements and deleting obsolete information. The TRM, in conjunction with the April 2015 TRICARE Policy Manual (TPM), 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 TRM 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.

April 1, 2015 edition

These manuals are applicable to the East and West Regional Managed Care Support Contracts awarded on or after 07/21/2016. Upon direction of the Contracting Officer, all or portions of these manuals may also apply to the TRICARE Quality Monitoring Contract (TQMC), TRICARE Claims Audit Review Services (TCARS), TRICARE Overseas Program (TOP), TRICARE Pharmacy (TPharm), TRICARE Dental Program (TDP), and TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC).
The April 1, 2015 edition of the TRICARE Reimbursement Manual (TRM), 6010.61-M, is available online.
All future changes will be published to this edition.
Last Updated: November 15, 2017
Most Recent Change Number: Change 10

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Page Count: 942
Summary of Changes: This change brings the TRICARE T17 manuals in line with T3 manuals and implements the mental health/SUD Final Rule published on September 2, 2016 with an effective date of October 3, 2016. This change updates and aligns mental health/SUD benefits with medical/surgical benefits by the elimination of differential mental health/SUD cost-sharing/co-payments (vis a vis medical/surgical care cost-shares and co-pays). It updates mental health/SUD benefits by (a) removing quantitative treatment limitations for mental health and SUD treatment; (b) expanding benefits for opioid treatment; and (c) streamlining requirements to become an authorized mental health/SUD provider. This change is published in conjunction with Apr 2015 TOM Change 9 and Apr 2015 TPM Change 13.