Provisional Coverage Program

The Provisional Coverage Program covers some emerging services and supplies.

• The first service offered under the program will be surgical treatment for Femoroacetbular Impingement (FAI), starting January 1, 2016.
• We'll add new services based on your needs.
• As we add new services, we'll list them here. Please check back for details.

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.

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

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, he/she 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 providerAn 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.