Safety Medical Supplies
Safety medical supplies are not a covered benefit; such as bath or toilet rails, helmets and childproof locks.
Screening Diagnostic Tests
Tests not related to a specific illness, injury or definitive set of symptoms are not covered, except for clinical preventive examinations. See preventive services for screening information.
A second opinion is when a physician other than the one you have previously seen, gives his or her view about your health condition and how it should be treated. It does not include the treatment itself. Getting a second opinion can help you make a more informed decision about your care. More >>
Sensory Integration Therapy
Not a covered benefit.
Services or Supplies Ordered by a Court or Government Agency
Not a covered benefit unless medically or psychologically necessary for the diagnosis or treatment of a condition.
TRICARE may cover intersex surgery to correct ambiguous genitalia when it has been documented to be present at birth. All other services and supplies related to sex gender change, also referred to as sex reassignment surgery, are not a covered benefit. See also Gender Dysphoria Treatment.
Sexual Abuse Treatment
Sexual abuse treatment is a covered benefit if accompanied by a valid mental health diagnosis. Also see psychotherapy.
Sexual Inadequacy or Dysfunction Treatment
Not a covered benefit.
The shingles, also known as zoster, vaccine is a TRICARE covered benefit for beneficiaries age 50 and older. More >>
Shoes, Shoe Inserts, Shoe Modifications and Arch Supports
Skilled Nursing Facility Care
A skilled nursing facility (SNF) admission is a limited benefit. More >>
Skin Cancer Screening
Skin cancer screening exams are covered at any age for beneficiaries with family or personal history of skin cancer, increased exposure to sunlight or clinical evidence of precursor lesions.
Sleep studies are covered under limited circumstances. More >>
Smoking Cessation Counseling
Smoking cessation counseling is a covered benefit for all TRICARE beneficiaries, except those eligible for Medicare, who live within the United States. More >>
Speech therapy is covered to improve, restore, or maintain function, or to minimize or prevent deterioration of function. More >>
Not a covered benefit.
Spravato Nasal Spray
Spravato®, also known as esketamine, nasal spray is a limited benefit for the treatment of treatment-resistant depression for beneficiaries 18 and older. An approval from Health Net Federal Services, LLC (HNFS) is required for all beneficiaries. Ketamine administered through subcutaneous, sublingual, IV, injectable, nasal spray, or orally is not a covered benefit. TRICARE follows the Centers for Medicare & Medicaid (CMS) billing guidelines for Spravato, which specify use of CPT® codes G2082-G2083 rather than E/M codes. See our Spravato Billing Tips page for more information.
Providers should complete our Spravato Letter of Attestation and attach it to the authorization request.
Spravato® is a registered trademark of Janssen Pharmaceuticals Inc.
CPT® is a registered trademark of the American Medical Association. All rights reserved.
Substance Use Disorder Treatment
Substance use disorder treatment is a limited benefit. More >>
Surgical Sterilization Reversals
Surgical sterilization reversals are a limited benefit, and may be covered when medically necessary for the treatment of disease or injury.
Services and supplies associated with maternity care, including antepartum care, childbirth, postpartum care and complications of pregnancy, may be cost-shared when the surrogate mother is a TRICARE beneficiary and has entered into a contractual agreement with the adoptive parents. The contractual agreement will be considered primary coverage. Any undesignated amount, or amount designated for medical expenses under the contract, must be exhausted before TRICARE will cost-share otherwise covered benefits for the TRICARE beneficiary.
Synagis®, also known as Palivizumab, is a limited benefit. Synagis is a medication that assists in the prevention of respiratory syncytial virus (RSV). Coverage is limited to one dose per month up to a maximum of five consecutive doses for newborns or infants with one of the following:
- Chronic lung disease
- Congenital heart disease
- Severe immunodeficiency
- Congenital abnormalities of the airway or neuromuscular disease (for example, cerebral palsy, muscular dystrophy, neurological diseases of the brain and spinal cord like Tay-Sachs disease or spinal muscular atrophy)
For most of the United States, RSV season begins in November and ends in March. In communities where there is elevated RSV viral isolation reported by either the Centers for Disease Control and Prevention or local public health authorities, RSV season may begin earlier. However, the duration of the Synagis injections remains five consecutive months for all geographic areas in the United States.
See also injection/infusion medication for additional information.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.