Autism Care Demonstration: Progress Note Requirements for Medical Team Conferences

Tuesday, October 31, 2023

People diagnosed with autism spectrum disorder can get help from different specialists. Under TRICARE’s Autism Care Demonstration (ACD), these qualified health care professionals (QHP) may meet in medical team conferences to talk about a patient’s care and progress. To comply with TRICARE requirements, QHPs must document their conference participation. Here’s a refresher on what Health Net Federal Services, LLC's (HNFS) medical documentation reviewers look for in the progress notes.

Requirements

• The appropriate Current Procedural Terminology (CPT®) codes have been billed. HNFS will authorize one unit each of CPT codes 99366 (patient present) and 99368 (patient not present) for each treatment period.
• An authorized ABA supervisor rendered the ABA services.
• At least three different QHPs who have seen the patient in the last 60 days were present at the conference. 
• The assigned Autism Services Navigators (ASN) attended (if applicable). Important: A TRICARE beneficiary’s assigned ASN must attend for providers to receive reimbursement.
• The conference was conducted in-person or via a HIPAA-compliant telehealth platform.
• All participants stayed throughout the conference.

Refer to TRICARE Operations Manual, Chapter 18, Section 4 and our Billing page for more information.

Exclusions 

Keep in mind, TRICARE excludes the following under the ACD:

• Teacher or Individualized Education Program (IEP) meetings billed as medical team conferences.
• Telephone-only medical team conferences.
• Non-health care professionals (such as school officials) documented as QHPs.

Common Progress Notes Errors 

Here are errors commonly identified by HNFS’ clinical reviewers:

• Fewer than three QHPs attending a medical team conference. 
• The rendering ABA provider's role in the medical team conference, including the provider’s contributions and treatment recommendations, not being detailed or included.

We encourage you to visit our ACD page for additional details about medical team conferences and related progress notes.