When do I need a referral for TRICARE?
Quick Answer
TRICARE Prime requires referrals for specialty care outside your PCM. TRICARE Select does not require referrals to see any authorized provider.
Related Video
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.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
See What's AvailableShare this page
Was this FAQ helpful?
Need personalized help with this?
Most military families leave benefits on the table. Our free 2-minute coverage check identifies gaps, finds potential savings, and gives you personalized recommendations.
Check My Coverage