TRICARE Coverage for Orthopedic Injuries & Joint Conditions
Overview
TRICARE provides comprehensive orthopedic coverage for injuries, chronic conditions, and surgical interventions. This includes physical therapy, orthopedic surgery, joint replacement, and rehabilitation. Orthopedic injuries are among the most common conditions treated in the military healthcare system.
Treatment Options Covered by TRICARE
- Orthopedic evaluation and imaging
- Physical therapy and rehabilitation
- Occupational therapy
- Joint replacement surgery (hip, knee, shoulder)
- ACL reconstruction
- Rotator cuff repair
- Spine surgery
- Arthroscopic procedures
- Cortisone injections
- Orthotics and bracing
- Durable medical equipment
- Chiropractic care (active duty only)
How TRICARE Covers Orthopedic Injuries & Joint Conditions
TRICARE covers all medically necessary orthopedic care. Physical therapy does not have a hard visit limit — it is covered as long as medically necessary and showing progress. Chiropractic care is covered for active duty at designated MTFs. Joint replacement and reconstructive surgery are fully covered with appropriate authorization.
Coverage by Plan
TRICARE Prime
Orthopedic visits at $0 with PCM referral. Physical therapy at $0. Surgery at $0 at MTF or authorized civilian facility.
TRICARE Select
Standard outpatient cost shares for office visits and therapy. Inpatient surgery subject to per-day charges. No referrals needed.
TRICARE For Life
Medicare covers orthopedic care with standard cost shares. TFL covers remaining balance. Joint replacement typically at $0 after Medicare + TFL.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Orthopedic evaluation (Prime ADFM) | $0 with referral |
| Physical therapy session (Prime ADFM) | $0 with referral |
| Physical therapy session (Select ADFM, network) | $28 copay |
| Knee replacement surgery (Prime ADFM) | $0 with authorization |
| MRI (Prime ADFM) | $0 with referral |
| Custom orthotics (with authorization) | $0 (Prime) / cost share (Select) |
Authorization Requirements
Orthopedic surgery and advanced imaging (MRI, CT) typically require prior authorization. Physical therapy may require authorization after initial evaluation. Durable medical equipment and custom orthotics require authorization.
Network & Provider Notes
Orthopedic surgeons, physical therapists, and sports medicine physicians are well-represented in the TRICARE network. MTFs often have orthopedic clinics with shorter wait times for active duty members.