Outpatient observation stays are a covered benefit when a hospital places a patient under observation, but has not admitted him or her as an inpatient. These services generally occur after an emergency room visit or after an outpatient surgical procedure (ambulatory surgery). While outpatient observation stays generally should not exceed 23 hours, up to 48 hours are covered when medically necessary.
The costs for these services are based on the related services: emergency room costs or ambulatory surgery costs. If an observation stay is for more then 48 hours, the costs for inpatient hospitalization or inpatient hospitalization for mental health will apply.
Obstructive Sleep Apnea Syndrome Treatment
Treatment of obstructive sleep apnea (OSA) syndrome is a limited benefit. More >>
Occupational therapy is covered to improve, sustain, or restore functions which have been lost or reduced as a result of injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, or developmental, learning or physical disability(ies), to the highest possible level for independent functioning. More >>
Office visits, also known as individual provider services, are covered. The following services may be included in an office visit:
- outpatient office-based medical and surgical care
- diagnosis and treatment by a specialist
- second opinions
- allergy tests and treatment
- osteopathic manipulation
- rehabilitation services, for example, physical therapy, speech pathology services and occupational therapy
- medical supplies used within the office, including casts, dressings and splints
Note: Clinical oral examinations and related radiographs and laboratory tests may be payable only when in conjunction with the diagnosis and treatment of covered adjunctive dental or oral surgery procedures.
Opioid Treatment Programs (OTPs)
Opioid treatment programs (OTPs) and office-based opioid treatment are covered benefits. See Medication Assisted Treatment for more information. In response to the COVID-19 pandemic, retroactive to March 13, 2020, the Defense Health Agency is temporarily allowing for OTPs to be rendered via telemedicine.
Orthodontia, such as braces or retainers, is a covered benefit only when related to the medical and surgical correction of a severe congenital abnormality such as a cleft palate or deformity of the head and neck. Dental benefits are available under the separate TRICARE dental programs. Also see adjunctive dental.
Orthoptics is not a covered benefit. Examples of orthoptics include vision therapy, eye exercises or visual training.
Orthotic devices are a covered benefit. However, benefits for foot orthotics and cranial orthotics are very limited. More >>
Any drug not requiring a physician’s prescription, even if a physician writes a prescription for such drugs, is not a covered benefit.