Does TRICARE cover autism services and therapy?

TRICARE provides comprehensive autism coverage:

Autism Care Demonstration (ACD) • Comprehensive treatment program • Covers all TRICARE beneficiaries • No age limits • Medically necessary services

Covered Services

Applied Behavior Analysis (ABA) • Evidence-based therapy • Intensive behavioral intervention • Supervised by certified professionals • Up to 35 hours per week possible

Speech-Language Therapy • Communication development • Language skills • Social communication

Occupational Therapy • Daily living skills • Sensory integration • Motor skills development

Physical Therapy • Gross motor skills • Movement development • Coordination

Psychiatric Services • Medication management • Mental health evaluations • Counseling services

Developmental Screenings • Early identification • Regular monitoring • Assessment services

How to Access

TRICARE Prime • Get referral from PCM • Coordinate with care team • Network providers required

TRICARE Select • Self-refer to ACD providers • Any certified ACD provider • File claims if needed

Prior Authorization • Required for ABA therapy • Provider submits request • Renewed periodically

Provider Requirements • Must be ACD-certified • Specialized autism training • Meet TRICARE standards

Cost-Sharing • Same as other medical services • Prime: Minimal copays • Select: Deductible + cost-shares • Counts toward catastrophic cap

No Limits On • Medically necessary care • Number of visits • Duration of treatment • Service combinations

Additional Support

ECHO Program • Extended Care Health Option • Additional benefits for qualifying disabilities • Respite care • Home health services • Specialized equipment

Comprehensive Care • Multidisciplinary approach • Care coordination • Family training and support • Regular progress monitoring

Important Notes • Diagnosis required from qualified provider • Treatment plan must be medically necessary • Regular reassessments required • Family participation encouraged

Finding Providers • Use TRICARE ACD provider directory • Ask for certified ACD providers • Verify current certification • Contact regional contractor for help

TRICARE's autism coverage is among the most comprehensive available, ensuring children and adults with autism receive needed care and support.