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When do I need a referral for TRICARE?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini)
Quick Answer
TRICARE Prime requires referrals for specialty care outside your PCM. TRICARE Select does not require referrals to see any authorized provider.
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Key Takeaways
- Prime requires referrals for specialists
- Select has no referral requirements
- Some services always excluded
- Point-of-service is self-refer option
Detailed Answer
Referral requirements depend on your TRICARE plan type.
TRICARE Prime - Referrals Required
- All specialty care needs referral from PCM
- Mental health (after first 8 sessions)
- Physical therapy (after initial evaluation)
- Tests and imaging ordered by specialists
- Non-emergency inpatient care
TRICARE Prime - No Referral Needed
- Emergency care
- Urgent care (when PCM unavailable)
- First 8 mental health visits
- OB/GYN routine care
- Eye exams for glasses
TRICARE Select - No Referrals
- Can see any TRICARE-authorized provider
- Specialists don't require referral
- May need pre-authorization for some services
Point-of-Service Option
- Prime members can self-refer
- Pays like out-of-network Select
- Higher costs but more flexibility
Getting a Referral
- Contact your PCM
- Referrals valid for specific time period
- Ensure authorization before appointment
Related TRICARE Terms
Related Questions
What is the difference between TRICARE Prime and TRICARE Select?
TRICARE Prime is a managed care option with a primary care manager and lower costs. TRICARE Select offers more flexibility to choose providers with higher out-of-pocket expenses.
What's the difference between a referral and prior authorization?
Referrals allow you to see specialists (Prime requirement). Prior authorization is approval needed before certain services regardless of plan.
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