Prior Authorization

A prior authorization (or preauthorization) is an approval for a health care service before you receive the care.

TRICARE Prime Options

TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, or TRICARE Young Adult-Prime

If you’re enrolled in a TRICARE Prime option, you must have a referral for all specialty care. This includes all active duty service members. If you need prior authorization, your primary care manager (PCM) will coordinate both the referral and prior authorization with your regional contractor.

TRICARE Standard Options

TRICARE Standard and Extra, TRICARE Standard Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult-Standard

If you’re using another TRICARE option, you must have prior authorization for the following services before getting care:

  • Adjunctive dental care
  • Applied behavioral analysis (referral from an authorized diagnosing provider also required)
  • Home health services (only available in the U.S. and U.S. Territories)
  • Hospice care (only available in the U.S. and U.S. Territories)
  • Nonemergency inpatient admissions for substance-use disorders or behavioral health
  • Outpatient behavioral health care beyond the eighth visit
  • Transplants (all solid organ and stem cell)
  • TRICARE Extended Care Health Option services

In addition to those services listed above, each region may require prior authorization for additional services:

Fitness-for-Duty Review for Active Duty Service Members

All active duty service members must get an additional fitness-for-duty review for maternity care, physical therapy, behavioral health services, family counseling, and smoking cessation programs.

Last Updated 1/21/2014