Provisional Coverage Program
The Provisional Coverage Program covers some services and supplies.
What do I need to know about the Provisional Coverage Program?
- Pre-authorization may be required for services and supplies in the program. It doesn't matter which TRICARE plan you're using.
- Provisional coverage for any approved service or supply can last up to five years.
- Provisional coverage for any approved service or supply may end before five years. We'll give timely notification of when it will end.
- We'll determine if the service or supply becomes a permanent TRICARE benefit. We'll do this before the five year provisional coverage period ends.
Currently Approved for Provisional Coverage
Ablative Fractional Laser (AFL) Treatment (Effective Feb. 24, 2021 through Feb. 23, 2026)
TRICARE covers AFL Treatment. This includes Carbon Dioxide Laser and Erbium: Yttrium-Aluminum Garnet Laser for symptomatic scars resulting from burns and other trauma. You must have one or more symptoms below.
- Physical functional impairment. This includes:
- Decreased range of motion with use of associated body part
- Problems with speaking, breathing, eating, or swallowing
- Visual impairments
- Skin integrity
- Nearby body part distortion
- Obstruction of an orifice
If you’re enrolled in TRICARE Prime, you must have a referral from your primary care manager. You don’t need a pre-authorization. You can also get care from a non-network provider.
3-D Mammography (Digital breast tomosynthesis) (Effective Jan. 1, 2020 through Dec. 31, 2024)
TRICARE will cover annual 3-D mammography screenings if you’re a woman who is:
- Age 40 or older
- Age 30 or older and at high risk (15% or more lifetime risk of breast cancer)
You won’t have any copayments or cost-shares if you get your annual screening 3-D mammography from a TRICARE network provider.
TRICARE Prime enrollees who have a referral from their primary care manager (PCM), can get an annual 3-D mammography screening from a non-network provider. Point-of-service fees apply if you don’t have a referral from your PCM.
For more information about mammogram coverage under TRICARE, visit Mammograms.
Platelet Rich Plasma (PRP) Injections (Effective Oct. 1, 2019 through Sept. 30, 2024)
TRICARE may cover PRP injections if you're diagnosed with:
- Mild to moderate chronic osteoarthritis of the knee
- Lateral epicondylitis, also known as "tennis elbow"
However, you must meet additional certain criteria for coverage. Call your regional contractor for more information.
Last Updated 9/16/2021