TRICARE Radiology & Imaging: Costs and Rules (2026)

*TRICARE.com is an independent reference site and is not affiliated with the official TRICARE program or the Department of Defense. For official policy, please visit TRICARE.mil.*

## Quick answer TRICARE covers radiology images (X-rays, MRIs, CT scans, and ultrasounds) when they are deemed medically necessary and ordered by a TRICARE-authorized provider. While standard X-rays generally do not require a referral, "high-tech" imaging like MRIs or PET scans usually require prior authorization from TriWest (West Region) or Humana Military (East Region).

In detail

TRICARE splits radiology into two categories: **routine diagnostic imaging** (standard X-rays, ultrasounds) and **high-tech imaging** (MRI, MRA, CT, PET scans). Coverage is contingent on the scan being used to diagnose or treat a specific medical condition.

### Prior Authorization Requirements * **TRICARE Prime:** You generally need a referral from your Primary Care Manager (PCM) for all imaging. For high-tech imaging, the regional contractor (TriWest or Humana Military) must also provide prior authorization. * **TRICARE Select:** You usually do not need a referral for standard X-rays or ultrasounds from a network provider. However, **prior authorization is mandatory** for high-tech imaging (MRIs, CT scans) to ensure the service is covered.

### Costs for Radiology (2026 Rates) Costs vary based on your beneficiary group (Group A or B) and the setting where the image is taken (outpatient office vs. hospital).

*Note: Group A began service before Jan 1, 2018. Group B began service on or after Jan 1, 2018.*

### Receiving Your Images Under current TRICARE policy, the government pays for the *interpretation* (the radiologist's report) and the *technical component* (the scan itself). If you need a copy of the actual images (on a CD or via a digital portal) to take to a specialist, the facility must provide these. While TRICARE does not usually charge for the digital transfer, some private facilities may charge a nominal administrative fee for physical media like a CD, which TRICARE may not reimburse.

## Who this applies to * **Active Duty Service Members (ADSMs):** Always covered with $0 out-of-pocket, but must have a referral and use military treatment facilities (MTFs) when available. * **Active Duty Family Members (ADFMs):** Covered under Prime or Select; high-tech scans always require authorization to avoid "Point of Service" charges. * **Retirees and their Families:** Subject to annual deductibles and cost-shares. * **TRICARE For Life (TFL) Users:** Medicare acts as the primary payer for radiology. TRICARE pays the remaining balance if the service is a TRICARE-covered benefit.

Common scenarios

**Scenario 1: Standard X-Ray for a Broken Bone (TRICARE Select)** John (a Group A retiree on TRICARE Select) trips and thinks he broke his arm. He goes to a network urgent care center. He does not need prior authorization for the X-ray. The facility charges $150. John pays his 20% cost-share (approx. $30) after his deductible is met.

**Scenario 2: MRI for Knee Pain (TRICARE Prime)** Sarah (an active duty spouse on TRICARE Prime) has chronic knee pain. Her PCM submits a referral for an MRI. TriWest Healthcare Alliance (West Region) reviews and approves the authorization. Sarah goes to a network imaging center. Her cost is **$0** because she followed the referral and authorization process.

**Scenario 3: Unauthorized MRI (TRICARE Prime)** If Sarah from the example above went to an imaging center without waiting for the TriWest authorization, she could be charged under the **Point-of-Service (POS) option**, resulting in a 50% cost-share and a separate deductible.

## Related terms * **Prior Authorization:** A formal approval required from Humana Military or TriWest before receiving "high-tech" scans. * **Point of Service (POS):** An option for Prime enrollees to see any provider without a referral, resulting in significantly higher out-of-pocket costs. * **Allowable Charge:** The maximum amount TRICARE will pay for a specific radiology procedure. * **Professional Component:** The fee paid to the radiologist for reading and interpreting the image. * **Technical Component:** The fee paid for the use of the equipment and the technician’s time.

## Sources * TRICARE.mil: X-Rays and Radiology [https://www.tricare.mil/CoveredServices/IsItCovered/XRays](https://www.tricare.mil/CoveredServices/IsItCovered/XRays) * Humana Military (East Region): [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * TriWest Healthcare Alliance (West Region): [https://www.triwest.com/](https://www.triwest.com/) * Defense Health Agency (DHA) Cost Sheets: [https://www.health.mil/](https://www.health.mil/)