Ambulatory Surgery: TRICARE Definition and Costs | TRICARE.com

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## Definition Ambulatory surgery refers to planned surgical procedures that do not require an overnight stay in a hospital, allowing you to be discharged on the same day as your operation.

## What it means in practice For TRICARE beneficiaries, ambulatory surgery—also known as outpatient or "same-day" surgery—can take place in two primary settings: a Hospital Outpatient Department (HOPD) or a free-standing Ambulatory Surgery Center (ASC). Under the current T-5 contract, these facilities are managed by Humana Military in the East Region and TriWest Healthcare Alliance in the West Region. Generally, TRICARE covers these procedures if they are medically necessary and recognized as safe for an outpatient setting (e.g., tonsillectomies, cataract removals, or arthroscopic knee repairs).

The cost to the beneficiary depends heavily on your TRICARE plan and whether the facility is in-network. For example, under **TRICARE Select** (Group A, 2026 rates), retirees and their families might see a fixed copayment for an ASC visit, whereas **TRICARE Prime** beneficiaries typically pay $0 for authorized surgery at a network facility. If you are an active duty service member (ADSM), your ambulatory surgery must be coordinated through your Primary Care Manager (PCM), and you are generally capped at $0 out-of-pocket.

It is critical to distinguish between the surgery and the facility. TRICARE may require **prior authorization** for specific types of surgery (like cosmetic procedures that have a medical necessity component) regardless of the setting. Always verify with Express Scripts if any medications required for post-operative recovery are covered under your pharmacy benefit.

If a surgery that was planned as "ambulatory" results in a complication that requires you to stay overnight, the status changes to "inpatient." This shift can trigger different cost-sharing rules, such as a per-day fee or a different deductible application, depending on your plan year 2026 enrollment status.

## Related terms * **Ambulatory Surgery Center (ASC):** A modern health care facility focused on providing same-day surgical care, often independent from a hospital. * **Prior Authorization:** A requirement for your doctor to get approval from Humana Military (East) or TriWest (West) before performing certain surgeries. * **Medically Necessary:** Services or supplies needed to diagnose or treat a medical condition that meet accepted standards of medical practice. * **Catastrophic Cap:** The maximum out-of-pocket amount you will pay for covered TRICARE services in a calendar year. * **Inpatient Care:** Health care that you get when you’re admitted to a hospital or other facility for at least one night.

## Sources * **TRICARE.mil:** [Ambulatory Surgery Center](https://www.tricare.mil/CoveredServices/IsItCovered/AmbulatorySurgeryCenter) * **Health.mil (Defense Health Agency):** [Outpatient Prospective Payment System](https://health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/Outpatient-Prospective-Payment-System) * **TriWest Healthcare Alliance:** [Provider Resources and Authorizations](https://www.triwest.com/)