Not a covered benefit; for example, camps for diabetes or weight loss.
Cancer clinical trials may be cost-shared for all TRICARE-eligible beneficiaries participating in NCI (National Cancer Institute) sponsored Phase I, Phase II and Phase III studies for the prevention, screening, early detection and treatment of cancer. More >>
See preventive services.
Hospital-based acute rehabilitation, including inpatient hospitalization and up to 36 outpatient sessions per cardiac event, may be covered. More >>
Cardiovascular disease screenings are a covered benefit, and include cholesterol and blood pressure checks. Cholesterol testing is a covered benefit once every five years beginning at age 18. TRICARE recommends blood pressure checks for children annually between ages three to five and every two years thereafter; and for adults a minimum every two years. View preventive services costs if rendered during a clinical preventive exam. There may be a cost share/copay if rendered during an office visit for a medical condition.
Chelation therapy is covered if the chelating agent is approved by the U.S. Food and Drug Administration (FDA) and used for an FDA-approved indication. Chelation therapy is a covered benefit when used to treat heavy metal toxicity, such as lead poisoning. Chelation therapy is not a covered benefit when used to treat cardiovascular disease, peripheral vascular disease, cancer, chronic fatigue syndrome, Alzheimer's disease, multiple sclerosis, autism, attention deficit hyperactivity disorder, or any other condition for which chelation therapy is not FDA-approved.
Chemotherapy and radiation for the treatment of cancer is a covered benefit. Chemotherapy agents must be approved by the U.S. Food and Drug Administration (FDA) and used for an FDA-approved indication or considered a standard of care. See also Cancer Clinical Trials.
Not a covered benefit; however, active duty service members may receive chiropractic services at select military treatment facilities. See chiropractic care for active duty service members for more information. Beneficiaries should contact their primary care provider to discuss and order any necessary services recommended by a chiropractor. See alternative resources.
A lipid panel for cholesterol testing is covered as recommended by the National Heart, Lung and Blood Institute. View preventive services costs if testing is done during a clinical preventive exam. There may be costs if testing is performed due to a diagnosis. See cost information for office visits.
Not a covered benefit.
Circumcision is covered as part of the inpatient services for a newborn. If a circumcision is performed after the child has been discharged from the hospital and is provided in an office-visit setting, it is cost-shared with office visit costs. If it is performed in an outpatient hospital or ambulatory surgery facility it is cost-shared with ambulatory surgery costs. Adult circumcisions may be covered if medically necessary and cost-shares are based on the type of location where the service is provided.
Implantation, to include the implants and the external speech processor device, is a covered benefit if approved by the U.S. Food and Drug Administration (FDA) and when used for approved indications. Cochlear implants are not covered if there is a contraindication for the surgery such as a middle ear infection, a lesion in the auditor nerve, poor anesthetic risk, severe mental retardation, severe psychiatric disorders, or organic brain syndrome. See also hearing aids. Costs may include hospitalization and durable medical equipment.
Routine colonoscopy, proctosigmoidoscopy, or sigmoidoscopy performed for colorectal cancer screening, in the absence of cancer or other presenting signs, is a limited benefit under TRICARE. More >>
Complications from non-covered services are only covered when the initial non-covered treatment was provided in a military treatment facility (MTF), authorized by the MTF Commander and the MTF was unable to provide the necessary treatment for the complication. All other treatment of complications, infection from non-TRICARE covered services or removal of non-covered implants are not a covered benefit.
Medical grade compression (pressure) stockings are a covered benefit as durable medical equipment. TRICARE covers two pressure stockings per limb per calendar year when medically necessary.
Not a covered benefit.
Consultations are a covered benefit. According to the American Medical Association CPT® PLUS 2013 policies, “a consultation is a type of evaluation and management service provided by a physician at the request of another physician or appropriate source to either recommend care for a specific condition or problem, or to determine whether to accept responsibility for ongoing management of the patient’s care or for the care of a specific condition or problem.”
If the referring physician does not make the request in writing and a report to the first physician is not requested, or if treatment is transferred to the consulting physician and the transfer is accepted prior to seeing the patient, the visit is not a consultation. Examples of non‐consultation visits include when a primary care manager refers a patient to a dermatologist for a skin disorder and asks the specialist to assume responsibility for the treatment, and when a patient visits a physician for the sole purpose of obtaining a second opinion from another provider.
CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Continuous Positive Airway Pressure (CPAP) machine also known as a respiratory assist device, is considered durable medical equipment (DME). CPAP machines are a limited benefit and may be covered for the following:
Variable Positive Airway Pressure (VPAP) or Adaptive Servo-Ventilation (ASV) machines, and an Intraoral Pressure Gradient device (also known as a WINX device) are considered unproven and are not covered benefits.
Non-prescription contraceptives are not a covered benefit. See birth control.
Umbilical cord blood banking is a limited benefit and only covered when the newborn beneficiary requires a transplant of cord blood. TRICARE does not cover cord blood banking for a healthy newborn. Prior authorization is required. If covered, separate outpatient costs may apply or they may be included in the inpatient hospital costs.
Cosmetic, plastic or reconstructive surgery is a limited benefit. It may be covered to restore function, correct a serious birth defect, restore body form after a serious injury, improve appearance after severe disfigurement after cancer surgery or breast reconstruction after cancer surgery. See alternative resources.
Cranial orthotic devices, or molding helmets, are covered only for postoperative use for infants (3–18 months) who have undergone surgical correction of craniosynostosis and have moderate-to-severe residual cranial deformities.
Cranial orthotic devices, or molding helmets, are not a covered benefit for treatment of nonsynostotic positional plagiocephaly or when used alone to treat craniosynostosis. See alternative resources.
Not a covered benefit. Custodial care provides support services for individuals who cannot care for themselves and do not require skilled medical care. Patients seeking these services may include those with a degenerative condition such as Parkinson's or ALS, a prolonged illness like cancer or a cognitive disorder like Alzheimer's. These support services may include activities of daily living such as dressing, bathing and using the bathroom. This type of care is often provided in a nursing home, assisted living facility or in a beneficiary’s home. See Alternative Health Care Resources.