Outpatient Observation Stays

TRICARE covers outpatient observation stays to determine if you need to be admitted to the hospital. Covered outpatient observation stays include the use of a bed and periodic monitoring by hospital staff.

Outpatient observation stays shouldn’t exceed 23 hours, but up to 48 hours may be authorized by your TRICARE contractor when medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition.. Time spent in a recovery room after surgery isn’t included in the outpatient 23-hour limit.

You’re considered to be an inpatient if:

• You’re formally admitted to the hospital.
• You’ll remain at least overnight or if the observation period lasts more than 48 hours.  

See Also

• Same-Day Surgery