REFERRALS AND PRE-AUTHORIZATIONS

Please see the below table for pre-authorization guidelines when receiving care overseas:

	TRICARE Prime Overseas	TRICARE Prime Remote Overseas	TRICARE Select Overseas (ADFMs)1	TRICARE Select Overseas (Retirees)1
Emergency Care*	Not Required	Not Required	Not Required	Not Required
Clinical Preventive Services	ADSM: Required ADFM: Not Required	ADSM: Required ADFM: Not Required	Not Required	Not Required
Mental Health Care	ADSM: Required ADFM: Not Required**	ADSM: Required ADFM: Not Required**	Not Required**	Not Required**
Specialty Care	Required	Required	Not Required	Not Required
Urgent Care***	Not Required	Not Required	Not Required	Not Required
Services Requiring Pre-Authorization	For all beneficiaries, regardless of which TRICARE Health Plan they are enrolled in, the following services require a pre-authorization: Adjunctive Dental Services Assisted Reproductive Technology (ART) (Supplemental Health Care Program (SHCP) ADSMs Only) Autism Care Demonstration (ADFMs Only) Dental Anesthesia and Institutional Benefits Extended Care Health Option (ECHO) Services (ADFMs Only) Femoral Acetabular Impingement Gastric Surgery for Morbid Obesity Home Health Care Services† Home Infusion Therapy† Hospice Care† Laboratory Developed Tests (Genetic Testing) Low Protein Modified Foods Mental Health Care Services (Includes Psychoanalysis, Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation, Acute Psychiatric Hospital Care, Substance Use Disorder Rehabilitation Programs) Organ/Stem Cell Transplants†† Partial Hospitalization Program (PHPs) and Intensive Outpatient Programs (IOPs) (ADSMs Only) Plastic Surgery (Includes Abdominoplasty, Lipedema, Reduction Mammaplasty, Other Plastic Surgery) Reproductive Health Residential Treatment Care (RTC) (ADFMs Under 21 Years of Age Only) Skilled Nursing Facility† Spravato™ (Esketamine) Nasal Spray † Limitations apply to facility charges in overseas locations; please contact your TOP Regional Call Center for more information. †† Medicare certification for organ transplant centers is only required for transplants performed in the United States and U.S. territories where Medicare is available. TRICARE may cover organ transplants in overseas locations when medically necessary, reasonable, and commonly accepted in the country where the transplant is performed.

The information above is not all-inclusive. There may be other services requiring pre-authorization, as these guidelines may change periodically. Contact your TOP Regional Call Center to learn more before receiving care. Additional information is also available on https://tricare.mil/CoveredServices and https://tricare.mil/FindDoctor/Appointments/Referrals.

NOTE: Some authorizations may include important instructions and exclusions (per TRICARE Policy) that apply for the authorized medical consultation. While an authorization confirms the coverage of the evaluation of the medical presentation, authorization for treatment ONLY applies to TRICARE-covered diagnostic procedures and treatments. If applicable, this specific information is displayed in the referral and instructions / exclusions fields of the authorization, under the heading “Important Authorization Coverage Information for TRICARE Overseas Program (TOP) Beneficiaries and Health Care Providers.” Please note that specific instructions and exclusions information may not be present in every authorization – only when needed to align with TRICARE Policy (e.g., non-covered services).

*International SOS should be notified within 24 hours of admission.

** Certain types of behavioral health care services, including non-emergency inpatient behavioral health care and inpatient admissions for substance use disorders, are excluded and always require a referral and pre-authorization. Contact International SOS for more details. You can get care from a supervised mental health counselor or pastoral counselor, but a doctor must supervise the care, even if in the TRICARE network. Certified mental health counselors don't need doctor referral and supervision.

*** While a referral is not required for Urgent Care if the care is a covered benefit and provided by a TRICARE-authorized provider, TOP beneficiaries can contact their TOP Regional Call Center to help ensure and facilitate cashless/claimless service.

¹Note: Beneficiaries who live or travel in the Philippines are required to see a certified provider for care. For more information, visit https://www.tricare-overseas.com/beneficiaries/philippines.