Reconstructive SurgeryTRICARE covers cosmetic, reconstructive and plastic surgery to improve the physical appearance of a beneficiary only under the following circumstances:
- Correction of a birth defect (includes cleft lip)
- Restoration of a body form following an accidental injury
- Revision of disfiguring and extensive scars resulting from neoplastic surgery (i.e., surgery that removes a tumor or cyst)
- Reconstructive breast surgery following a medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. mastectomy
- Reconstructive breast surgery due to a congenital anomaly (birth defect)
- Penile implants and testicular prostheses for conditions resulting from organic origins or for organic impotency
- Surgery to correct pectus excavatum
- Liposuction when medically necessary
- Panniculectomy (tummy tuck) performed in conjunction with an abdominal or pelvic surgery when medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.
To be covered, surgeries must be performed no later than December 31st of the year following the accidental injury or surgical trauma, except in the case of postmastectomy reconstructive breast surgery or cases involving children who may require a growth period.
TRICARE doesn't cover cosmetic, reconstructive or plastic surgery related to:
- Dental congenital anomalies
- Elective correction of minor skin blemishes and marks
- Breast augmentation
- Face lifts
- Reduction mammoplasties (breast reductions), except in the case of significant pain due to large breasts
- Blepharoplasty (removal of excess skin of the eyelid)
- Rhinoplasties (nose surgery)
- Chemical peeling for the treatment of facial wrinkles or acne scars
- Hair transplants
- Removal of tattoos
- Liposuction for body contouring.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 6/18/2020