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Approval Requirements for Ancillary Services

Ancillary services, also referred to as diagnostic services, allow providers to assess patients and determine appropriate treatment. Examples include most laboratory and radiology tests, echocardiograms, holter monitors, pulmonary function tests, and routine treadmill tests.

Most ancillary services do not require a separate approval from Health Net Federal Services, LLC (HNFS); however, for TRICARE Prime patients, the services must be ordered by the primary care manager or a specialist the patient was approved by HNFS to see.

Ancillary Service Code List

Our TRICARE Ancillary Services list specifies approval requirements for covered CPT® codes. If the approval column indicates “NO,” a doctor’s order given to the patient is sufficient. HNFS does not need to review or approve. 

This list is subject to change. 

Note: Some services have benefit limitations. Please refer to the TRICARE Policy Manual and the Benefits A–Z pages for complete benefit details.

*When opening the Excel file, we recommend not saving it, as it is subject to change. To search for codes or code descriptions, use the drop-down arrows located in row 3. You can also press the "Ctrl" and "F" keys on your keyboard simultaneously to open the "Find and Replace" box. Type a keyword in the "Find What" box and click the "Find All" button to see the search results. 

Episode of Care Examples

Visit our Episode of Care page for examples that can help you understand when and when not to submit a new request to HNFS.