last updated June 22, 2022
See "Test to Treat Initiative" and "Treatments" below for additional information.
Test to Treat Initiative
Get tested and treated in one place.
TRICARE continues to cover medically necessary COVID-19 tests ordered by a TRICARE-authorized provider and performed at a TRICARE-authorized lab or facility. Test types include diagnostic, tests for management of COVID-19, and serology/antibody tests.
FDA-approved at-home antigen rapid diagnostic test kits may be covered with a physician's order.
There are no copayments or cost-shares for covered tests.
Ouside of the TRICARE beneift, other options for free at-home testing include:
- The federal government offers residential households in the U.S. a limited number of free at-home antigen rapid diagnostic tests. To order, go to: https://www.covidtests.gov
- In some cases, military hospitals and clinic personnel may provide at-home tests to TRICARE-eligible beneficiaries. Beneficiaries should check with their local military hospital or clinic for availability.
- Search for a community-based testing site for no-cost COVID-19 testing options.
- Beneficiaries who have other private or employer-sponsored health insurance may be eligible for reimbursement for up to eight at-home COVID-19 tests per month (per individual) without a doctor's order under that health plan.
Reminder: The current mandate for private insurance companies to cover FDA-approved at-home COVID-19 tests without a physician’s order does not apply to TRICARE. Currently, TRICARE requires medical necessity and a physician’s order.
See our Clinical Trials page.
Oral Anti-Viral Treatment
The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Paxlovid® and Molnupiravir® for the treatment of mild-to-moderate COVID-19. Paxlovid and Molnupiravir oral anti-viral treatments may be prescribed to those who have tested positive. The FDA recommends Paxlovid as a first line treatment; Molnupiravir is used as a last resort due to relatively lower efficacy and some exclusions for use in pregnancy. Beneficiaries can fill prescriptions for these treatments at network, non-network or military pharmacies, subject to availability.
Monoclonal Antibody Treatment
UPDATE: As of Jan. 24, 2022, the FDA has revoked the Emergency Use Authorization (EUA) for two of the four EUA-approved COVID-19 monoclonal antibodies due to ineffectiveness against the current primary variant, Omicron. EUAs are still in place for one outpatient and one inpatient monoclonal antibody treatment. Read more at www.phe.gov.
Under the FDA’s EUA for COVID-19 monoclonal antibodies, high-risk COVID-19 patients may be eligible for monoclonal antibody treatment. Per the FDA, high risk includes those age 12 years and older who have a medical condition or other factor that puts them at risk for severe COVID-19 progression.
- Patients must have a positive COVID-19 test or COVID-19 exposure.
- A physician's order with the EUA indication for treatment is needed.
- Prior authorization is required for monoclonal antibody infusion therapy administered in the home under the home infusion benefit.
- TRICARE Prime referral rules apply.
Currently, there are two locators – one kept by HHS and another by the National Infusion Center Association (NICA) – for providers and military hospitals and clinics to check for local facilities that are providing COVID-19 monoclonal antibody infusion:
Variants continue to spread, especially in areas where vaccination rates are low. Continue to encourage COVID-19 vaccination for your patients. TRICARE covers age-appropriate vaccines in accordance with Centers for Disease Control and Prevention (CDC) guidelines.
- Prior authorization is not required. Visit our Benefits A–Z section for benefit details and updates.
- Vaccine confidence: Check out the Centers for Disease Control and Prevention's (CDC) Vaccinate with Confidence campaign to increase COVID-19 vaccine confidence and uptake.
- Children and teens: The CDC recommends children ages 6 months and older get a COVID-19 vaccine. Everyone 5 years and older should also get a COVID-19 booster, if eligible. The pediatric dose is one-third of the adult dose and administered with smaller needles designed specifically for children. Learn more: COVID-19 vaccines for children and teens
- Additional primary doses and boosters:
- The CDC recommends a third dose of the Pfizer or Moderna vaccine for those who have certain immunocompromising conditions. The third dose is to be given 28 days after second dose.
- The CDC recommendations for COVID-19 booster shots vary based on age, medical history and vaccine type. When to get a booster varies by vaccine type. Current CDC guidelines allow for "mix and match" for booster doses.
- COVID-19 vaccines and pregnancy: The CDC recommends COVID-19 vaccination for women who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
- Flu + COVID-19 vaccines: The flu and COVID-19 vaccines can be given together.
- Are you interested in becoming a COVID-19 vaccine provider? Find details, including the required CDC COVID-19 Vaccination Program Provider Agreement. Providers enrolled in the program must monitor and comply with CDC COVID-19 Vaccination Program requirements.
Changes to Your Practice? Let Us Know!
Network providers are required to promptly notify us of any demographic updates (changes, additions, deletions) as they occur. This helps ensure beneficiaries seeking health care services and providers seeking to refer care are viewing the most current and accurate provider information.
We recognize your locations, contact information, telehealth capabilities, and/or accepting new patients status may have changed due to COVID-19 impacts. Please visit our online Network Provider Directory to confirm your individual listing is accurate.
Most demographic updates can be made online. Learn more.
Now, more than ever, it’s important we help beneficiaries connect with providers who can see them via virtual appointments.
What is TRICARE's telemedicine benefit?
TRICARE covers medically and psychologically necessary telehealth services. TRICARE policy guidelines and exclusions apply. See our Telemedicine Services page for details.
How is telemedicine billed?
Visit our Telemedicine Billing page for details.
How can I help my patients locate a telemedicine provider?
We’ve recently updated our online Network Provider Directory to help those in their telemedicine provider search. Select “Telemedicine” to get started.
How do I get listed as a telemedicine provider in the network directory?
Use our updated TRICARE Provider Group Roster Template to let us know which providers in your practice offer video telemedicine services. If you use a different template, please indicate on it who offers telemedicine services.
While TRICARE is temporarily allowing for audio-only telehealth, at this time, directory search results will only include providers who offer video telemedicine services. As such, please only identify on your roster those providers who offer video telehealth.
You must be in the TRICARE West Region network to be listed in our directory. If you have multiple state licenses, list them separately (by row) on the roster. You do not need to resubmit past rosters.
Billing Code Updates
Does TRICARE cover new COVID-19 related codes as they are introduced by CMS?
As with all new Current Procedural Terminology (CPT®) and Common Procedure Coding System (HCPCS) codes, TRICARE reviews them against policy to determine coverage. Our claims system is updated regularly to include added codes. Claims may be delayed to allow for appropriate code approval and system updates.
What are the CDC recommendations for preventing the spread of COVID-19 and other viral illnesses?
Review CDC guidelines at www.cdc.gov/COVID19 and www.cdc.gov/coronavirus/2019-ncov/faq.html.
Where can I find current guidelines for health care providers?
Review the CDC’s guidance for health care professionals. Be sure to get a detailed travel history for patients who present with flu-like illness.
What recommendations should I give to patients who are concerned they may have COVID-19 or believe they have been in contact with someone with the virus?
- Seek medical advice.
- Call ahead before going to a doctor’s office or emergency room.
- Tell your doctor about recent travel and your symptoms.
- Some providers offer telemedicine as an alternative to coming into the office. TRICARE covers medically-necessary telemedicine services when all criteria are met. Learn more on our Telemedicine Services page.
- If your primary doctor is not available, TRICARE beneficiaries can go to any TRICARE-authorized urgent care center or if necessary, an emergency department.
- TRICARE beneficiaries who need health advice can contact the Military Health System’s Nurse Advice Line 24/7.
- Avoid contact with others and do not travel while sick.
- Learn more at www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html.
What can one do while sick to prevent the spread to others?
The best way to prevent illness from spreading is to avoid exposing others. Stay home except to get medical care, and separate yourself from other people and animals in your home.
For those planning travel to abroad:
View the CDC’s current travel notice and FAQs.
For travelers already in where the virus may be present.
View the CDC’s current travel notice and FAQs.
For travelers returning from areas with the virus.
United States residents who travel to other countries where this outbreak has occurred may be screened upon re-entry to the U.S.
Source: Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/index.html