TRICARE Benefit Updates: Lipectomy, Platelet-Rich-Plasma, Botox

Monday, August 19, 2024

Please note the following TRICARE benefit updates:

Retroactive to May 28, 2021, TRICARE may cover lipectomy (liposuction) for the treatment of lipedema when specific conditions are met. Patients must have a clinical diagnosis of lipedema stage I, II or III; be 18 years of age or older; have a body mass index less than 30; and meet the clinical guidelines specified in TRICARE Policy Manual (TPM), Chapter 1, Section 6.1 and Chapter 4, Section 2.1. Pre-authorization is required.  

Separately, TRICARE will not cover the following services as they have been identified as unproven:

• Platelet-rich-plasma (PRP) for all indications, effective Oct. 1, 2024 (TPM, Chapter 4, Section 6.1)
  
  
• Botulinum toxin A (Botox) for the treatment of myofascial pain dysfunction syndrome (also known as temporomandibular joint [TMJ] syndrome), retroactive to Oct. 12, 1988 (TPM, Chapter 7, Section 27.1)

Find full details in the TPM, available at manuals.health.mil.