When does TRICARE require a referral?

Direct answer: TRICARE Prime requires a referral for covered care you do not get from your primary care manager, with narrow exceptions. TRICARE Select usually does not require a referral, and some services still need pre-authorization.

Applies to: All TRICARE plans · All regions

Details

The official referral table includes TRICARE Prime, Prime Remote, TRICARE Young Adult-Prime, and the US Family Health Plan on the referral side. An active duty service member needs a referral for care the primary care manager does not provide. Other Prime beneficiaries need a referral for covered services outside the primary care manager, except preventive care and outpatient mental health from a network provider in the region. Select, Reserve Select, Retired Reserve, For Life, and Young Adult-Select usually do not need a referral for primary or specialty care. Applied behavior analysis needs a referral. Pre-authorization is a separate approval for some procedures.

What to do next

Confirm this with your Primary Care Manager or regional contractor before scheduling — rules can vary by region and by service.