TRICARE Coverage for Orthopedic Injuries & Surgery (2026)

*TRICARE.com is an independent reference site and is not a government agency. For official policy and the most current regulatory updates, please visit TRICARE.mil.*

## Is it covered? Yes, TRICARE covers the diagnosis and treatment of orthopedic injuries when they are deemed medically necessary and proven. This includes coverage for broken bones, ligament tears, joint replacements, and physical therapy required for recovery.

## What TRICARE covers TRICARE generally covers any orthopedic service that is a professional standard of care for injury recovery. This includes:

* **Diagnostic Imaging:** X-rays, MRIs, CT scans, and bone scans to assess the extent of the injury. * **Surgical Procedures:** Arthroscopic surgery, joint replacements (hip, knee, shoulder), and fracture repairs (ORIF). * **Emergency Care:** Initial stabilization of acute injuries at an Emergency Room or Urgent Care center. * **Durable Medical Equipment (DME):** Braces, casts, splints, crutches, walkers, and wheelchairs. * **Physical and Occupational Therapy:** Rehabilitation services to restore function following an injury or surgery. * **Injections:** Corticosteroid injections and certain viscosupplementation for joint issues (though PRP/prolotherapy may be restricted or considered experimental).

**What is NOT covered:** * **Experimental Treatments:** Procedures or biological therapies not yet cleared by the FDA or the Defense Health Agency (DHA) as proven. * **Exercise Equipment:** Home gym equipment or hot tubs, even if recommended for rehab. * **Foot Orthotics:** Generally not covered unless they are part of a leg brace or for specific medical conditions like diabetes.

## Costs Costs for orthopedic care depend on your beneficiary category (Group A vs. Group B) and your specific plan. For 2026, the following general rates apply:

* **TRICARE Prime:** Active Duty Service Members (ADSMs) have $0 out-of-pocket costs. Family members and retirees usually pay $0 for in-network referrals, though small copays may apply for outpatient specialty visits (often ranging from $25–$40 in 2026). * **TRICARE Select:** For 2026, retirees and their families typically pay a deductible followed by a cost-share. Outpatient specialty visits usually incur a fixed copay (approx. $35–$60) or a 20-25% cost-share of the TRICARE-allowable amount. * **TRICARE For Life (TFL):** TFL acts as secondary payer to Medicare. If Medicare covers the orthopedic service, TFL typically pays the remaining balance, resulting in $0 out-of-pocket for the beneficiary.

*Note: Use the TRICARE Compare Cost tool at TRICARE.mil for specific 2026 figures based on your enrollment group.*

## Pre-authorization & referrals The requirement for a referral depends largely on your plan:

* **TRICARE Prime:** You **must** obtain a referral from your Primary Care Manager (PCM) for all non-emergency orthopedic specialty care. Failure to do so will result in "Point of Service" charges, which are significantly higher. * **TRICARE Select:** You generally **do not** need a referral to see an orthopedic specialist. However, certain procedures (like high-cost surgeries or specific DME) may require **prior authorization** from your regional contractor (Humana Military or TriWest). * **Active Duty:** Always requires a referral for any civilian specialty care.

## Where to get care To ensure the lowest out-of-pocket costs, you should seek care from a TRICARE network provider.

* **East Region:** Use the **Humana Military** provider directory to find orthopedic surgeons and physical therapists. * **West Region:** As of 2025/2026, the West Region is managed by **TriWest Healthcare Alliance**. Use their online directory to find in-network specialists. * **Military Treatment Facilities (MTF):** Prime enrollees are often seen by military orthopedic surgeons at base hospitals if capacity is available.

## Sources 1. [TRICARE.mil: Orthopedic Care Policy](https://www.tricare.mil/CoveredServices/IsItCovered/OrthopedicTreatments) 2. [TRICARE Policy Manual 6010.63-M: Surgery and Related Procedures](https://manuals.health.mil/) 3. [TRICARE.mil: Physical Therapy Coverage](https://www.tricare.mil/CoveredServices/IsItCovered/PhysicalTherapy) 4. [Defense Health Agency (DHA) T-5 Contract Guidelines](https://health.mil)