TRICARE Coverage for Traumatic Brain Injury (TBI) | TRICARE.com

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## Is it covered? Yes, TRICARE covers the diagnosis and treatment of Traumatic Brain Injury (TBI). Coverage includes emergency care, diagnostic imaging, inpatient rehabilitation, and various outpatient therapies deemed medically necessary for recovery.

## What TRICARE covers TRICARE provides a comprehensive benefit for TBI, focusing on both the acute injury phase and long-term neuro-rehabilitation. Covered services include:

* **Diagnostic Testing:** MRI, CT scans, and neuropsychological testing to determine the extent of the brain injury. * **Cognitive Rehabilitation Therapy (CRT):** Specialized therapy to improve memory, attention, and executive functioning (must be medically necessary and provided by a licensed clinician). * **Physical and Occupational Therapy:** To help regain motor skills and daily living activities. * **Speech-Language Pathology:** For patients experiencing speech or swallowing difficulties post-injury. * **Behavioral Health:** Counseling and psychiatric care for common TBI comorbidities like depression, anxiety, or PTSD. * **Inpatient Rehabilitation:** Intensive care at a certified brain injury rehabilitation facility. * **Home Health Services:** If the beneficiary is homebound due to the severity of the TBI.

**Exclusions:** * Non-medical "brain training" apps or games. * Experimental or unproven treatments (e.g., hyperbaric oxygen therapy for certain chronic TBI symptoms is often scrutinized and requires specific clinical trial conditions). * Custodial care (assistance with bathing or dressing only) is generally not covered unless part of a broader skilled nursing plan.

## Costs Costs for TBI treatment depend on your beneficiary status (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. Retirees and family members pay $0 for TBI-related care at Military Treatment Facilities (MTFs). In town, retirees pay a small copay (approx. $25–$35 for specialty visits in 2026). * **TRICARE Select:** Beneficiaries usually pay an annual deductible ($150–$300 for individuals) and then a percentage of the allowable charge. For 2026, network specialty office visits typically cost $35–$55. * **TRICARE For Life (TFL):** TFL acts as secondary payer to Medicare. If Medicare covers the TBI service, TRICARE typically covers the remaining out-of-pocket costs.

*Note: Inpatient rehabilitation is usually covered as an institutional fee, which may involve a per-day charge for retirees on Prime or a daily cost-share for Select users.*

## Pre-authorization & referrals * **Active Duty Service Members:** Always require a referral for TBI specialty care (Neurology, Speech Therapy, etc.) and usually require pre-authorization from their Primary Care Manager (PCM). * **TRICARE Prime (Non-Active Duty):** Require a PCM referral for specialty care. If you see a TBI specialist without a referral, Point-of-Service (POS) charges—which are significantly higher—will apply. * **TRICARE Select:** No referral is required for most TBI-related outpatient therapies, but **prior authorization** is often required for inpatient rehabilitation and certain high-cost diagnostic scans or long-term therapeutic regimens.

## Where to get care TBI care should ideally begin at a Military Treatment Facility if specialized TBI clinics (like the Intrepid Spirit Centers) are available. For civilian care: * **East Region:** Contact **Humana Military** to find network neurologists and rehab facilities. * **West Region:** Contact **TriWest Healthcare Alliance** (the current contractor as of 2025/2026) to locate TBI specialists. * **Pharmacy:** Recovery medications are managed through **Express Scripts**.

## Sources 1. [TRICARE Policy Manual 6010.63-M: Cognitive Rehabilitation Therapy](https://manuals.health.mil/) 2. [TRICARE.mil: Traumatic Brain Injury Overview](https://www.tricare.mil/HealthWellness/Conditions/TBI) 3. [Defense Health Agency: TBI Center of Excellence](https://health.mil/TBI)