Does TRICARE Cover ADHD Testing & Treatment?

Does TRICARE Cover ADHD Testing & Treatment?

Yes, TRICARE covers psychological testing and assessment to aid in diagnosing a patient and developing a treatment plan for someone with attention deficit hyperactivity disorder  (ADHD). Psychological testing for academic placement, however, is not covered.¹

Jump to Section

• Does TRICARE Insurance Cover ADHD Testing & Treatment?
• How to Verify TRICARE ADHD Coverage
• What Is ADHD?
• Does TRICARE Cover ADHD Testing?
• Does TRICARE Cover ADHD Treatments & Medications?
• How To Find TRICARE ADHD Testing & Treatment Clinics Near Me?
• How Much Does ADHD Testing & Treatment Cost Without Insurance?

How to Verify TRICARE ADHD Coverage

To determine if your TRICARE ADHD coverage includes ADHD assessments and treatment in Tennessee, call your insurance company or contact Athena Care below. One of our care coordinators can help you navigate your insurance coverage and help you get the care you need. We’re in-network with most major insurance and we offer comprehensive ADHD services.

What is ADHD?

Attention Deficit Hyperactivity Disorder, or ADHD, is a widespread neurobehavioral condition marked by persistent issues with executive functioning skills, such as brain activities that control attention, memory, organization, motivation, impulsivity, hyperactivity, time management, social skills, and other functions. These problems begin in childhood and can last a person’s entire life, resulting in unstable relationships, subpar school or work performance, low self-esteem, and other concerns.

Signs & Symptoms of ADHD

Children with ADHD may do these things significantly more often than other children: 

• Daydream, seem lost in thought 
• Forget or lose things 
• Squirm or fidget, have trouble sitting at the dinner table or school 
• Talk too much 
• Make careless mistakes 
• Take unnecessary risks, act before thinking 
• Have a hard time resisting temptation 
• Have trouble taking turns, blurt out answers, or frequently interrupt others 
• Have difficulty getting along with others
• Take longer to perform tasks or hurry through them
• Have low self-esteem 

For adults with ADHD, symptoms typically begin in childhood and don’t disappear. However, if symptoms start after childhood, other diagnoses may be considered. In addition, adults with ADHD often don’t know they have it – they just know that everyday tasks seem more challenging for them than for most people. Signs and symptoms of ADHD in adults may include:

• Feeling or thoughts of life as an endless race to keep up with work, family members, and social responsibilities, as unfinished projects, chores, and paperwork pile up around them.  
• Overlooking essential details, getting derailed by distractions, losing track of time, and missing deadlines.  
• Experiencing quick, intense emotions and becoming highly agitated when waiting in line or driving in traffic. 
• Feelings that they perform consistently below their potential and assuming that their issues result from laziness, lack of willpower, or poor self-control. 

Does TRICARE Cover ADHD Testing?

TRICARE ADHD testing may be covered depending on your specific insurance plan’s benefits and whether or not your testing is required for academic purposes.

TRICARE covers medically and psychologically necessary mental health care.² When the requirements of the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5)³ are met, services for the treatment of ADHD are considered medically required.

Unfortunately, no specific tests can diagnose ADHD. An ADHD diagnosis is clinical, based on the results of the history, physical examination, and patient/family interviews. The following are some of the well-known diagnostic techniques for assessing ADHD:

• An interview with the parent and the child (to rule out other psychiatric or environmental causes of symptoms)

• A medical examination includes a thorough medical history and a physical exam (to check for coexisting conditions). Oppositional defiant disorder, conduct disorder, depression, anxiety disorder, and learning difficulties are common coexisting psychiatric and developmental disorders in children diagnosed with ADHD.

• An electroencephalogram (EEG) or a neurological consult if focused signs or clinical findings point to a seizure disorder or a degenerative neurological condition.

To diagnose and treat ADHD, a variety of specialists are available. Child psychiatrists, family physicians, pediatricians, psychiatrists, and neurologists are just a few examples. In addition, individual and/or family psychotherapy may be used to treat ADHD.

Relationships, quality of life, productivity, and mental health are all harmed when ADHD is left untreated. In addition, it’s connected to multiple negative consequences, including:

• Underachievement in school and at work

• Self-esteem issues

• Substance use disorders

• Employment issues

• Increased rates of divorce

• Increased rates of depression and anxiety

Does TRICARE cover ADHD Treatments & Medications?

Yes. TRICARE may cover specific ADHD treatments, and most TRICARE health plans include medication management services.⁴ The TRICARE Formulary⁵ lists covered prescription pharmaceuticals,⁶ including generic and brand-name medications. TRICARE ADHD medication coverage includes most prescription medications approved by the Food and Drug Administration (FDA).

Psychostimulant drugs, such as methylphenidate and other amphetamines, are the most well-studied and widely prescribed medications for ADHD. In addition, the American Academy of Pediatrics (AAP) recommends that children with ADHD be treated with both medication and/or behavioral therapy.

Following the administration of medications, patients should be closely monitored, and medicine should be taken consistently. Then, the doctor can check to see if the patient is getting the correct dose. After a few weeks on the medication, the side effects usually fade. Alternatively, the dosage might be reduced to minimize side effects.

Cigna ADHD medication coverage may include:

• Stimulants⁷
  • Stimulant medications, like Adderall or Ritalin, are commonly used to treat ADHD. These medications work for people of all ages to alleviate symptoms. Behavioral changes are usually rapid and significant.

• Non-Stimulants
  • If stimulant medications cause unpleasant side effects or are ineffective, a doctor may prescribe a non-stimulant medication, like Strattera. These can be taken on their own or in combination with stimulants.

• Complementary or Alternative Medicines
  • Some therapists and other health professionals employ complementary or alternative medicines. TRICARE only covers some of these therapies that are part of a treatment plan at one of the following types of facilities:
    • Inpatient treatment center
    • Treatment for substance use disorder in a residential setting
    • Residential psychiatric treatment facility (Those under age 21)
    • Part-time hospitalization program (PHP)
    • Intensive Outpatient Program (IOP)

How To Find TRICARE ADHD Testing & Treatment Clinics Near Me?

With Athena Care, gaining access to ADHD testing clinics in Tennessee has never been easier. Allow one of our care coordinators to assist you with any questions or concerns about TRICARE ADHD treatment coverage at one of our various Tennessee locations.

Athena Care health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m.

When choosing TRICARE ADHD doctors for ADHD testing and treatment, it’s important to ask questions and to keep the following in mind:

• Education, training, license, and years of experience
• Specialties and services offered
• Treatment methods and philosophies
• Insurance companies they work with
• Office hours
• Pricing
• Session length

You’ll find a list of practitioners organized by city, as well as information about their backgrounds and specialties here.

How Much Does ADHD Testing & Treatment Cost Without Insurance?

The following are average costs for therapy, though they may differ by location and other variables and may not reflect the actual cost of treatment or what you may pay in the state of Tennessee.

Doctor’s visits alone can range from a few hundred dollars to more than $2,700, and the cost of medication can go anywhere from $8 to $288 per month. For example, a month’s supply of widely prescribed generic stimulants costs around $187.97.⁸

In the United States, the typical cost of psychotherapy ranges from $100 to $200⁹ a session, dependent upon the state and the length of the session.

In addition, cognitive behavioral therapy (CBT) sessions can cost between $100 and $200 per session, while dialectical behavior therapy (DBT) usually consists of a weekly individual therapy session, a weekly group therapy session, and weekly phone conversations. DBT costs vary depending on the type of services rendered.

Telehealth treatment for ADHD patients is also beneficial. Telehealth sessions for the treatment of ADHD can range from anywhere from $150 – $200, depending upon Tennessee’s treatment options and whether or not your TRICARE ADHD coverage includes it.¹⁰