Ultrasounds that are medically necessary are covered. Also see maternity ultrasounds for benefit limitations. The use of 3D and 4D rendering and routine screening for breast disease are not a covered benefit.
Unproven Drugs, Devices, and Medical Treatment
Not a covered benefit unless the off-label use is determined to be medically necessary and research indicates the use is safe, effective and in accordance with accepted standards of practice in the medical community.
Urgent care is a covered benefit when related to an illness or injury that requires medically necessary treatment within 24 hours. Urgent care visits are typically at a primary care manager's office or an urgent care center.
- TRICARE Prime beneficiaries, excluding active duty service members (ADSMs) enrolled in Prime, do not need a referral for urgent care and Point of Service will not apply when seeking urgent care from a network or non-network urgent care center or a network primary care type provider.
- Active duty service members enrolled in TRICARE Prime still require a referral for urgent care; however, ADSMs enrolled in TRICARE Prime Remote do not require a referral due to their remote location.
- All other beneficiaries do not require a referral for urgent care, and care may be rendered by network or non-network providers.
Beneficiaries assigned to a military or civilian primary care manager (PCM) should seek all non-emergency follow-up care with their PCM.