Exclusions

• Acupuncture
• Alterations to living spaces
• Artificial insemination, including in vitro fertilization, gamete intrafallopian transfer, and all other such reproductive technologies
• Autopsy services or post-mortem examinations
• Birth control/contraceptives (non-prescription)
• Bone marrow transplants for treatment of ovarian cancer
• Camps (e.g., for weight loss)
• Care or supplies furnished or prescribed by an immediate family member
• Charges that providers may apply to missed or rescheduled appointments
• Counseling services that are not medically necessary to treat a diagnosed medical condition (e.g., educational, vocational, and socioeconomic counseling; stress management; lifestyle modification
• Custodial care
• Diagnostic admissions
• Domiciliary care
• Dyslexia treatment
• Electrolysis
• Elevators or chairlifts
• Exercise equipment, spas, whirlpools, hot tubs, swimming pools, health club memberships, or other such charges or items
• Experimental or unproven procedures
• Foot care (routine), except if required as a result of a diagnosed, systemic medical disease affecting the lower limbs, such as severe diabetes
• General exercise programs, even if recommended by a physician and regardless of whether rendered by an authorized provider
• Inpatient stays:
  • For rest or rest cures
  • To control or detain a runaway child, whether or not admission is to an authorized institution
  • To perform diagnostic tests, examinations, and procedures that could have been and are performed routinely on an outpatient basis
  • In hospitals or other authorized institutions above the appropriate level required to provide necessary medical care
• Learning disability services
• Medications:
  • Drugs prescribed for cosmetic purposes
  • Fluoride preparations
  • Food supplements
  • Homeopathic and herbal preparations
  • Multivitamins
  • Over-the-counter products (except insulin and diabetic supplies)
  • Weight reduction products
• Megavitamins and orthomolecular psychiatric therapy
• Mind expansion and elective psychotherapy
• Naturopaths
• Non-surgical treatment for obesity or morbid obesity
• Personal, comfort, or convenience items, such as beauty and barber services, radio, television, and telephone
• Postpartum inpatient stay for a mother to stay with a newborn infant (usually primarily for the purpose of breastfeeding the infant) when the infant (but not the mother) requires the extended stay, or continued inpatient stay of a newborn infant primarily for purposes of remaining with the mother when the mother (but not the newborn infant) requires extended postpartum inpatient stay
• Preventive care, such as routine, annual, or employment-requested physical examinations; routine screening procedures; or immunizations, except as provided under the clinical preventive services benefit (See “Clinical Preventive Services” earlier in this section.)
• Psychiatric treatment for sexual dysfunction
• Services and supplies:
  • Provided under a scientific or medical study, grant, or research program
  • Furnished or prescribed by an immediate family member
  • For which the beneficiary has no legal obligation to pay or for which no charge would be made if the beneficiary or sponsor were not TRICARE-eligible
  • Furnished without charge (i.e., cannot file claims for services provided free of charge)
  • For the treatment of obesity, such as diets, weight-loss counseling, weight-loss medications, wiring of the jaw, or similar procedures (For gastric bypass, see “Services or Procedures with Significant Limitations” earlier in this section.)
  • Inpatient stays directed or agreed to by a court or other governmental agency (unless medically necessary)
  • Required as a result of occupational disease or injury for which any benefits are payable under a workers’ compensation or similar law, whether such benefits have been applied for or paid, except if benefits provided under these laws are exhausted
• Sex changes or sexual inadequacy treatment, with the exception of treatment of ambiguous genitalia that has been documented to be present at birth
• Smoking cessation supplies
• Sterilization reversal surgery
• Surgery performed primarily for psychological reasons (such as psychogenic surgery)
• Therapeutic absences from an inpatient facility, except when such absences are specifically included in a TRICARE-approved treatment plan
• Transportation, except by ambulance
• Travel, even if prescribed by a physician, to obtain medical care
• X-ray, laboratory, and pathological services and machine diagnostic tests not related to a specific illness or injury or a definitive set of symptoms, except for cancer-screening mammography, cancer screening, Pap tests, and other tests allowed under the clinical preventive services benefit

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