Eligibility Overview
Understanding who qualifies for Tricare-covered ABA therapy.
Tricare Beneficiaries
Active duty service members, retirees, and their eligible family members with valid Tricare coverage.
Autism Diagnosis
A formal autism spectrum disorder diagnosis from a qualified healthcare provider is required.
PCM Referral Process
How to obtain the necessary referral from your Primary Care Manager.
Schedule PCM Appointment
Contact your Primary Care Manager to discuss your child's developmental concerns.
Request ABA Referral
Ask your PCM for a referral to ABA therapy services for autism treatment.
Obtain Referral Documentation
Receive the referral documentation needed for authorization.
Contact Kudos
We'll take it from there, handling the authorization process with Tricare.
Autism Diagnosis Requirements
What's needed for Tricare to authorize ABA therapy.
- Formal autism spectrum disorder (ASD) diagnosis
- Diagnosis from a qualified provider (psychiatrist, psychologist, developmental pediatrician)
- Current diagnostic evaluation (typically within 12 months)
- Documentation of medical necessity for ABA therapy
What Tricare Covers
Understanding your ABA therapy benefits under Tricare.
Assessment
Initial and ongoing evaluations by BCBAs.
Therapy Sessions
Direct ABA therapy hours with trained therapists.
Supervision
BCBA oversight and treatment plan management.
What Families Pay
For most Tricare beneficiaries, ABA therapy comes at little to no out-of-pocket cost.
$0
Typical Out-of-Pocket Cost
Tricare typically covers 100% of authorized ABA therapy costs for eligible beneficiaries.
How Authorizations Work
We handle the authorization process so you don't have to.
Initial Authorization
- We submit all required documentation
- Typically 2-4 weeks for approval
- Coverage for assessment and initial hours
Ongoing Authorizations
- Regular re-authorizations managed by us
- Progress reports submitted as required
- Seamless continuation of services
State Differences
Important considerations for Florida, Georgia, and Oklahoma families.