Prosthetic Devices and Supplies
|Covered by TRICARE?||Limits|
TRICARE covers prosthetics, prosthetic devices, and prosthetic supplies necessary because of significant conditions resulting from trauma, congenital anomalies or disease.
TRICARE also covers:
- Any accessory or item of supply that is used with the device for the purpose of achieving therapeutic benefit and proper functioning
- Services necessary to train the recipient of the device in the use of the device
- Repair of the device for normal wear and tear or damage
- Customization of the prosthetic when provided by an authorized provider.
- Replacement when required due to:
- growth or a change in the patient's condition,
- if the device is lost or irreparably damaged, or
- the cost of repair would exceed 60 percent of the cost of replacement.
- Surgical implants that are approved for use in humans by the U.S. Food and Drug Administration (FDA)
Prosthetic devices with an FDA-approved investigational device exemption (IDE) categorized by the FDA as non-experimental/ investigational (FDA Category B) will be considered for coverage. Coverage is dependent on the device meeting all other requirements of the law and rules governing TRICARE and upon the beneficiary involved meeting FDA-approved IDE study protocols.