Does TRICARE cover cosmetic or plastic surgery?

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Quick Answer

TRICARE covers reconstructive surgery for medical needs like post-mastectomy reconstruction, birth defects, and trauma repair, but not purely cosmetic procedures for appearance.

Key Takeaways

Cosmetic surgery not covered
Reconstructive surgery covered
Medical necessity required
Authorization often needed

Detailed Answer

TRICARE distinguishes between cosmetic and reconstructive surgery:

NOT Covered (Cosmetic)

Facelifts
Liposuction for appearance
Breast augmentation (cosmetic)
Nose jobs for appearance
Eyelid surgery for aesthetics
Body contouring (most cases)

COVERED (Reconstructive)

Post-mastectomy breast reconstruction
Repair of birth defects
Trauma reconstruction
Burn reconstruction
Functional nose surgery (breathing)
Eyelid surgery affecting vision

Medical Necessity Determines Coverage

Must correct functional impairment
Required for health, not appearance
Documented medical need
Physician recommendation

Examples of Covered Procedures

Breast reconstruction after cancer
Cleft palate repair
Skin grafts after burns
Hernia repair
Deviated septum repair

Getting Approval

Physician documents medical necessity
May need specialist referral
Prior authorization often required
Appeals possible if denied

Helpful Tips

Document functional impairment
Get specialist recommendation
Understand authorization process

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