Provisional Coverage Program

The Provisional Coverage Program covers some emerging services and supplies.

What do I need to know about the Provisional Coverage Program?

  • We require prior authorization for all services and supplies in the program regardless of your TRICARE plan.
  • We’ll offer provisional coverage for any approved service or supply for up to five years.
  • We can end provisional coverage for any approved service or supply at any time.
  • Before the five year provisional coverage expires, we’ll determine if the service or supply becomes a permanent benefit.

Provisional Coverage of Surgical Treatment of FAI

What is FAI?

FAI is a condition that affects the hip joint. It occurs when some portion of the soft tissue around the hip socket gets pinched or compressed. It causes pain that limits a person's mobility.

What is the provisional coverage for treatment of FAI?

TRICARE covers surgical treatment for FAI when you meet certain criteria. We cover surgical treatment that's open, arthroscopic, or a combined approach. The goal of the hip surgery is to improve the hip joint range of motion and improve or alleviate pain by restoring normal anatomy.

How do I know if this treatment is right for me?

You'll follow your plan's rules for getting care. 

Generally speaking:

  • If you want to learn more about this treatment, talk to your doctor. 
  • Your doctor will decide if you should be seen by a specialist—an orthopedic surgeon. 
    • Please note: If you're not enrolled in a TRICARE Prime plan, you can see the specialist without a referral.
  • If the orthopedic surgeon thinks you may benefit from surgical treatment, they will work with your regional contractor to get prior authorization.
  • When authorized, you can get the surgery at a military hospital or clinic or from any TRICARE-authorized providerClick to closeAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. 

When does the provisional coverage of FAI begin?

  • Provisional coverage of FAI begins on January 1, 2016.
  • There is no retroactive coverage.
  • It will end on December 31, 2020 unless we end it early or it becomes a permanent benefit.

How much will it cost?

Your plan and where you get the surgery determines your cost. >>View Your Costs.

What if I still have questions?

If you still have questions, please contact your regional contractor.

Last Updated 8/21/2017