TRICARE Coverage for Traumatic Brain Injury (TBI)
Overview
TRICARE provides comprehensive coverage for traumatic brain injury (TBI) from initial diagnosis through long-term rehabilitation. TBI is recognized as a signature injury of modern military service, and TRICARE has developed specialized programs and coverage to address the full spectrum of TBI severity.
Treatment Options Covered by TRICARE
- Emergency neurological evaluation
- Neuroimaging (CT, MRI)
- Neuropsychological testing
- Cognitive rehabilitation therapy
- Speech-language therapy
- Occupational therapy
- Physical therapy and vestibular rehabilitation
- Psychiatric and psychological support
- Medication management
- Residential rehabilitation programs
- Long-term assisted living (severe TBI)
How TRICARE Covers Traumatic Brain Injury (TBI)
TRICARE covers all medically necessary TBI care from acute treatment through long-term rehabilitation. There are no arbitrary limits on cognitive rehabilitation visits when medically necessary. The National Intrepid Center of Excellence (NICoE) provides specialized TBI care for service members. ECHO benefits may apply for dependents with TBI.
Coverage by Plan
TRICARE Prime
All TBI treatment covered with referral. Specialized military TBI centers available. Cognitive rehab and therapy at $0.
TRICARE Select
Standard cost shares for outpatient therapy. Inpatient rehabilitation subject to per-day charges. No referral needed.
TRICARE For Life
Medicare + TFL covers rehabilitation services. Long-term cognitive support covered.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Emergency evaluation (all plans) | $0 — emergency care never requires authorization |
| Neuropsychological testing (Prime) | $0 with referral |
| Cognitive rehabilitation (Prime ADFM) | $0 with referral |
| Speech therapy for TBI (Select ADFM) | $28 network copay |
| Inpatient rehabilitation (Prime ADFM) | $0 with authorization |
Authorization Requirements
Emergency TBI care never requires prior authorization. Inpatient rehabilitation, residential treatment, and long-term care require authorization. Outpatient therapy initiated after evaluation may require ongoing authorization reviews.
Network & Provider Notes
TRICARE network includes neurologists, neuropsychologists, and specialized rehabilitation facilities. Military treatment facilities with TBI programs include the NICoE at Walter Reed and other specialized centers.