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TRICARE Reference Room (Article 2) |
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Review Coverage Limitations and Exclusions
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TRICARE covers most inpatient and outpatient care that is medically necessary and appropriate. However, there are special rules or limits on some types of care, while other services may not be covered at all. The following information offers a review of what’s covered and what’s not for your TRICARE patients.
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Services Covered with Significant Limitations |
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On the next page is a table, listing medical, surgical and behavioral health care services that may be covered under TRICARE with significant limitations. This list is not intended to be all-inclusive. |
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Exclusions |
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In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including behavioral disorder), injury, pregnancy or well-child care. All services and supplies (including inpatient institutional costs) related to a non-covered condition or treatment, or provided by an unauthorized provider, are excluded. The following specific services are excluded from TRICARE under any circumstance. This list is not intended to be all-inclusive.
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- Acupuncture
- Artificial insemination
- Autopsy services or postmortem examinations
- Care that is not medically or psychologically necessary
- Birth control (nonprescription)
- Camps (such as for weight loss)
- Care or supplies furnished or supplied by an immediate family member
- Diagnostic admissions
- Experimental or unproven procedures
- Laser/LASIK/Refractive corneal surgery
- Psychological testing for learning disabilities
- Megavitamins and orthomolecular psychiatric therapy
- Mind expansion and elective psychotherapy
- Naturopaths
- Sex changes or sexual inadequacy treatment
- Telephone counseling consultation
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TRICARE beneficiaries may choose to obtain services that are not covered by TRICARE, but they must be informed in advance and in writing of specific services or procedures that are not covered by TRICARE before they are provided. Beneficiaries may choose to sign a Request for Non-Covered Services Form, which is a waiver agreeing to pay for non-covered services. To protect yourself, make sure you understand TRICARE’s “hold harmless” policy. Learn more in your TRICARE Provider Handbook in the section titled, “Provider Responsibilities”. You can also call 1-800-444-5445 for more information. |
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