Experimental Procedure

An experimental or investigational procedure is a medical treatment, drug, or device that has not yet been proven safe and effective through adequate clinical evidence. TRICARE generally does not cover experimental or investigational services unless they meet specific criteria.

TRICARE defines experimental/investigational as: • Not approved by the FDA for the proposed use • Not recognized as safe and effective by authoritative medical literature • Under clinical investigation or study • Not yet accepted as standard medical practice

Exceptions where coverage may apply: • FDA-approved clinical trials meeting TRICARE criteria • Compassionate use or expanded access programs approved by FDA • Treatments that become standard of care during review • Services specifically authorized by TRICARE demonstration projects

Appeal process for denied experimental procedures: • Request a reconsideration through your regional contractor • Provide supporting medical literature and clinical evidence • Your provider can submit additional documentation • Formal appeals can be escalated through TRICARE's appeals process

If you believe a treatment classified as experimental is medically necessary, work with your provider to explore coverage options, including clinical trial participation or formal appeals.