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.
- See Your Plan's Rules for Booking Appointments
- See Your Plan's Rules for Referrals and Prior Authorization
- 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