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    v1.0.30
    OpenPayerPolicy UpdatesClinical/Medical PolicyDHA ECHO Training Coverage Update | OpenPayer
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    CurrentDHAPolicy 2.1

    TRICARE Policy Manual Coverage Framework

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    This document is a table of contents for the DHA TRICARE Policy Manual, organizing provider policies across clinical and administrative services; it does not contain substantive coverage requirements.

    Policy Summary
    PayerDHA
    PolicyTRICARE Policy Manual Coverage Framework
    Policy CodePolicy 2.1
    Change TypeNo material change
    Effective DateSep 1, 2005
    Next Review DateNot specified
    Key ActionVerify that ECHO training satisfies all applicable ECHO requirements and supports an eligible qualifying purpose before seeking cost-sharing.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    9Policy manual chapters identified
    57Manual revision
    TRICARELine of business
    6CPT codes listed
    3Training categories addressed
    1Explicit Basic Program exclusion

    ECHO Training Coverage Criteria

    Assistive technology and disability-reduction training

    Training may be cost-shared as an ECHO benefit when the applicable ECHO requirements are met.

    Assistive technology or disability-reduction training: Training is required to allow use of an assistive technology device or to acquire skills expected to assist the beneficiary in reducing the disabling effects of a qualifying condition.

    Subject to all applicable ECHO requirements.

    Parent, guardian, and sibling training

    Family training may be cost-shared when it is required as an integral part of managing the qualifying condition.

    Family management training: Training is provided to a parent, guardian, or sibling of an ECHO beneficiary and is required as an integral part of management of the qualifying condition.

    Subject to all applicable ECHO requirements.

    Policy Summary
    PayerDHA
    PolicyTRICARE Policy Manual Coverage Framework
    Policy CodePolicy 2.1
    Change TypeNo material change
    Effective DateSep 1, 2005
    Next Review DateNot specified
    Key ActionVerify that ECHO training satisfies all applicable ECHO requirements and supports an eligible qualifying purpose before seeking cost-sharing.
    SourceLink
    On This Page
    ECHO Training Coverage CriteriaApplicable CPT CodesProvider Billing and Eligibility ActionsPurpose of ECHO Training Benefits

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Vocational training

    Vocational training is an allowed ECHO benefit.

    Vocational training is provided in the beneficiary's home or in a facility providing vocational training.

    The policy identifies vocational training as an allowed ECHO benefit.

    Authorized provider and service setting

    Eligible ECHO training may be provided in appropriate settings by authorized providers.

    Provider and setting: Services are cost-shared through ECHO, provided by an authorized institutional or individual professional provider, delivered on an inpatient or outpatient basis, and rendered in the beneficiary's natural environment when suitable for the services.

    Natural environment examples include the home, school, or another suitable location.

    Training services available under the TRICARE Basic Program are not eligible to be cost-shared under the Extended Care Health Option (ECHO).

    Applicable CPT Codes

    CPT CodesCPT
    97504
    97520
    97535
    97542
    99199
    99600

    Provider Billing and Eligibility Actions

    Denial Risk

    Exclude Basic Program training

    Do not submit training services available under the TRICARE Basic Program for ECHO cost-sharing. These services are not eligible to be cost-shared under the ECHO.

    Prior Authorization

    Verify ECHO requirements and qualifying purpose

    Before seeking ECHO cost-sharing, confirm that the training satisfies all applicable ECHO requirements and is required for the qualifying purpose. The training must support use of an assistive technology device, help reduce the disabling effects of a qualifying condition, or be an integral part of managing the qualifying condition.

    • Assistive-technology or disability-reduction training must allow device use or help the beneficiary acquire skills expected to reduce disabling effects.
    • Parent, guardian, or sibling training must be required as an integral part of managing the qualifying condition.

    Purpose of ECHO Training Benefits

    ECHO training may support a beneficiary’s use of an assistive technology device or acquisition of skills expected to help reduce the disabling effects of a qualifying condition. It may also include training for parents, guardians, or siblings when integral to managing the qualifying condition, as well as vocational training.