TRICARE Child and Adolescent Mental Health Coverage Guide

*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program. For official policy and the most current directives, visit TRICARE.mil.*

## Quick answer TRICARE covers a wide range of mental health and substance use disorder services for children and adolescents, including outpatient therapy, intensive outpatient programs, and residential treatment centers. While active duty family members usually pay $0 for these services, some levels of care—like residential treatment—require pre-authorization from your regional contractor (Humana Military or TriWest).

Details

TRICARE divides child and adolescent mental health care into outpatient and inpatient/residential categories. The type of care required determines whether you need a referral or prior authorization.

### Outpatient Therapy and Office Visits For most plans (TRICARE Prime, Select, and Reserve Select), children can see a TRICARE-authorized mental health provider for routine outpatient therapy. * **Referrals:** Active duty family members on TRICARE Prime do not need a referral for the first eight outpatient sessions per fiscal year with a network provider, but it is highly recommended to coordinate with a Primary Care Manager (PCM) for long-term care. * **Costs (2026 Rates):** * **Active Duty Family Members (Group A):** $0 copay for outpatient visits. * **Retirees and Families (Group A):** Approximately $38 per visit (Select) or $22 per visit (Prime network). *Note: Exact 2026 rates may vary by a few dollars based on the annual COLA adjustment.*

### Intensive Outpatient Programs (IOP) and Partial Hospitalization (PHP) These are structured programs for children who need more support than weekly therapy but do not require 24/7 supervision. * **Requirements:** Prior authorization is required. * **Coverage:** TRICARE covers these programs when provided by a TRICARE-certified facility. This includes treatment for depression, anxiety, and eating disorders.

### Residential Treatment Centers (RTC) For children under age 21 who require a 24-hour therapeutic environment, TRICARE covers Residential Treatment Centers. * **Eligibility:** The child must have a diagnosed mental health disorder that cannot be safely or effectively treated at a lower level of care. * **Authorization:** This **always** requires pre-authorization. If you reside in the West Region, you must coordinate through TriWest; in the East Region, through Humana Military. * **Duration:** Coverage is based on medical necessity. TRICARE will continue to pay as long as the facility provides evidence that the child requires that level of care.

### Applied Behavior Analysis (ABA) Mental health services for children with Autism Spectrum Disorder are provided through the **Autism Care Demonstration (ACD)**. This is a specialized program with distinct rules, requiring a referral from a PCM and a specialized diagnosis from a verified provider.

## Who this affects * **Active Duty Family Members (ADFMs):** Children of active-duty service members are eligible for the most comprehensive coverage with the lowest out-of-pocket costs. * **Retirees and their Families:** Children of retirees are covered, though they face higher cost-shares and enrollment fees. * **TRICARE Reserve Select (TRS) / TRICARE Retired Reserve (TRR) Enrollees:** Children in these plans have access to the same mental health benefits but pay monthly premiums and deductible-based cost shares. * **Survivors:** Spouses and children of deceased service members maintain eligibility for mental health services.

## Sources 1. **TRICARE.mil:** [Mental Health Care Overview](https://www.tricare.mil/MentalHealth) 2. **TriWest Healthcare Alliance (West Region):** [Mental Health Services](https://www.triwest.com/en/beneficiary/health-care-services/mental-health/) 3. **Humana Military (East Region):** [Behavioral Health Resources](https://www.humanamilitary.com/beneficiary/health-and-wellness/health-programs/behavioral-health) 4. **Defense Health Agency (DHA):** [Residential Treatment Center Guidelines](https://health.mil/Military-Health-Topics/Conditions-and-Treatments/Mental-Health)