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coverage
Does TRICARE cover cosmetic or plastic surgery?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini, gpt-4o)
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.
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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