Portable CPAP Machines, Sensory Integration Training, Sleep Studies, Hearing Aids, and Home Infusions
This page covers how the TRICARE West Region covers travel continuous positive airway pressure (CPAP) machines, sensory integration training, sleep studies, hearing aids, and home infusions.
Portable CPAP Machines
TRICARE covers portable or travel CPAP machines if the patient meets the following conditions:
- The patient is an active duty service member (ADSM)
- The patient has a referral that specifies these three items:
- They have an obstructive sleep apnea diagnosis.
- They travel on official business at least three days per month, or they are about to be deployed.
- They are not going to retire or separate from the military within the year.
The patient can get a CPAP machine from the following sources:
- Sleep specialist
- Pulmonary medicine
- Sleep lab
- Other providers with expertise in sleep disorders
All portable CPAP machines must have humidification capabilities and use portable batteries. Only active duty service members can receive authorizations for portable CPAP machines. To qualify, the service member must meet one of the following criteria:
- The service member is deploying.
- The service member is traveling for official business at least three days per month.
If the ADSM already has a CPAP machine for home use, TRICARE can still authorize a portable CPAP machine if they meet the above criteria.
If TRICARE authorizes the ADSM to receive a portable CPAP machine and the ADSM doesn’t have a standard CPAP machine, the ADSM will only receive authorization for a portable CPAP machine.
All providers referring their patients for portable CPAP machines must document that their patient has obstructive sleep apnea and meets TRICARE travel requirements.
For more information on how TRICARE covers CPAP machines, visit the TRICARE CPAP Machine page.
Sensory Integration Training
Sensory integration training (SIT) is an occupational therapy approach that uses structured, play-based, sensory-motor activities to improve a child’s adaptive responses to sensory experiences and functional participation. Occupational therapists typically provide this and deliver in clinics equipped with sensory-rich equipment.
SIT, which may be considered a component of cognitive rehabilitation, is not a proven therapy. TRICARE does not pay for SIT by itself or with other therapies, such as occupational, physical, or speech therapy.
Sleep Studies
Providers can use sleep studies to monitor a patient's sleep cycle and diagnose any potential sleep problems. Sleep studies can help diagnose conditions including, but not limited to, the following:
- Narcolepsy
- Obstructive sleep apnea syndrome
- Impotence
- Abnormal sleep behavior, such as sleepwalking, bruxism, and more
Under TRICARE, ADSMs who need a sleep study must get a referral. Referrals for sleep studies can come from the patient’s primary care manager (PCM) or a specialty provider. TRICARE policy specifies the following priority order for where the ADSM should get the sleep study:
- A Military Treatment Facility (MTF) sleep laboratory
- A network sleep laboratory
- A non-network, TRICARE-authorized sleep laboratory
- A sleep study conducted at home if travel to a sleep laboratory is not possible
Keep in mind that a sleep disorder diagnosis may affect the ADSM's ability to be deployed, readiness, and disability status, which may lead to their discharge from service.
For more information on sleep studies, visit the TRICARE Sleep Studies page and the Sleep Studies Quick Reference Guide.
Hearing Aids
TRICARE only covers hearing aids if the patient has profound hearing loss. To qualify as having profound hearing loss, the patient must meet these conditions:
- Adults must have at least one of the following conditions:
- A hearing threshold of at least 40 dB HL in one or both ears when tested at 500, 1000, 1500, 2000, 3000, or 4000Hz
- A hearing threshold of at least 26 dB HL in one or both ears at any three or more of the above frequencies
- A speech recognition score less than 94%
- Children must have the following condition:
- A hearing threshold of at least 26 dB HL in one or both ears when tested at 500, 1000, 1500, 2000, 3000, or 4000Hz
TRICARE does not cover hearing aids for retirees. However, retirees may obtain hearing aids through other government programs. These programs include:
Through RACHAP, beneficiaries may be able to buy hearing aids for a reduced cost at certain military hospitals and clinics. To qualify, the beneficiary must be eligible for care at a military hospital or clinic. The military hospital or clinic provides the fitting and follow-up services. Participation in RACHAP may depend on the following:
- Space
- Equipment
- Provider availability
Contact your military hospital or clinic to check availability.
TRICARE only covers hearing aids and hearing aid services for children of retired service members if the child meets the following criteria:
- Has hearing loss that meets the specified hearing criteria listed above
- Is enrolled in TRICARE Prime or US Family Health Plan
- Has a living sponsor
- Meets one of the following age requirements:
- Under 21 years old
- A full-time college aged 21-23
- Unable to support themselves due to a disability that started before age 21 (or before age 23 if they were a student when the disability began)
For more information on hearing aid coverage, visit the TRICARE Hearing Aids page.
Note: TRICARE does not cover hearing aids for tinnitus if the patient does not have profound hearing loss.
Home Infusion Therapy
TRICARE authorizes home infusion therapy for homebound patients and, in limited situations, for non-homebound patients for limited periods of time.
Home infusion therapy may include the following:
- Skilled nursing services to administer the drug
- Drug compounding services
- Medical supplies and durable equipment
The requirements vary depending upon whether a patient is homebound or non-homebound.
Homebound Beneficiaries
Providers should confirm the criteria listed in Chapter 12 of the TRICARE Reimbursement Manual (TRM) are met for homebound beneficiaries receiving Home Health Care under a Plan of Care.
Homebound beneficiaries who require skilled services (e.g., skilled nursing) for administering a home infusion drug must receive those skilled services from a Home Health Agency. Homebound beneficiaries who desire to self-administer (or have a caregiver administer) an infusion drug obtained from a TRICARE-authorized pharmacy under the TRICARE Pharmacy (TPharm) contract may do so when a physician or other authorized individual professional provider certifies that self-administration is medically appropriate. The physician or other authorized provider will document this certification in the patient’s POC or in their medical record.
Note: See TRM, Chapter 2, Addendum A for beneficiary cost-shares for HHC services. See TRM, Chapter 2, Addendum B for beneficiary cost-shares for the TPharm Benefits Program.
Non-Homebound Beneficiaries
Providers must submit preauthorization for non-homebound beneficiaries to receive home infusion therapy when the beneficiary needs long-term infusion therapy services (more than five sequential infusions). Home infusion therapy will be preauthorized when all of the following criteria are met:
- The attending physician certifies that the beneficiary, or caregiver, is capable and willing to learn to self-administer.
- The provider determines that self-administration in the home is medically appropriate.
- The TRICARE-authorized provider has preauthorization for up to five sequential skilled nursing visits to administer and instruct the beneficiary or caregiver to self-administer the drug.
- The provider coordinates and provides a referral to the TPharm for the drug and compounding services. If not available through TPharm, the provider supplies the drug through an appropriate TRICARE authorized provider or directs the beneficiary to care in an alternative setting.
- The provider ensures the beneficiary has a referral to all medically necessary and appropriate services and supplies for infusion therapy in the home.
Note: See TRM, Chapter 2, Addendum A for beneficiary cost-shares for HHC services. See TRM, Chapter 2, Addendum B for beneficiary cost-shares for TPharm Benefits Program.