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Ancillary Services

Ancillary services are a covered benefit and can be provided at any TRICARE network or non-network hospital, medical office or freestanding location. It's important for TRICARE beneficiaries to seek care from a network provider, as they can deliver services at a lower out-of-pocket cost for the beneficiary. For TRICARE Prime enrollees, the services must be ordered by the primary care manager (PCM) or by the specialist who has an approval from HNFS. View our Approval Requirements for Ancillary Services page for codes, descriptions and examples of when and when not to submit a request to HNFS. 

Also see Diagnostic Radiology.

Below is a list of CPT® codes that may be considered ancillary services:

  • Diagnostic radiology and ultrasound services CPT codes 70010 through 76999
  • Diagnostic imaging studies CPT codes 77001 through 77022, 77053 through 77084
  • Diagnostic nuclear medicine services CPT codes 78012 through 78999
  • Pathology and laboratory services CPT codes 80047 through 89247; 36400 through 36425; 36591 through 36592
  • Cardiovascular studies CPT codes 93000 through 93355
  • Fetal monitoring for CPT codes 59020, 59025 and 59050

Some CPT codes in the ranges above are excluded or have coverage limitations. Visit the Prior Authorization, Referral and Benefit tool for additional information. 

Cost Information
 

 

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