TRICARE Radiology Coverage & Costs Guide 2026 | TRICARE.com

Radiology refers to medical imaging used to diagnose and treat injuries and diseases, including X-rays, MRIs, CT scans, and ultrasounds.

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## Definition Radiology is a branch of medicine that uses imaging technology, such as radiation or sound waves, to see inside the body and diagnose or treat health conditions.

## What it means in practice For TRICARE beneficiaries, radiology is categorized as an "ancillary service." Whether you need a simple X-ray for a suspected broken bone or a complex PET scan for cancer staging, coverage depends on your specific plan (Prime vs. Select) and whether the imaging is considered "routine" or "high-tech."

Routine radiology, such as standard X-rays, ultrasounds, and mammograms, typically does not require a prior authorization if performed by a network provider. High-tech imaging, however—including MRIs, MRA, CT scans, and PET scans—almost always requires pre-authorization from your regional contractor (Humana Military in the East or TriWest in the West), except in emergency situations. If you are using TRICARE Prime, you generally need a referral from your Primary Care Manager (PCM) for any imaging performed outside of a Military Medical Treatment Facility (MTF).

Costs for radiology vary by beneficiary category and plan year. For example, in 2026, TRICARE Select Group A retirees usually pay a percentage (20–25%) of the allowable charge for outpatient radiology services, while TRICARE Prime active duty family members often have a $0 copayment when using network providers. If you receive radiology services while admitted to a hospital, the cost is typically bundled into the inpatient stay fee rather than billed as a separate radiology charge.

It is important to ensure your imaging facility is in-network. While Express Scripts manages your pharmacy benefits, your regional contractor (Humana Military or TriWest) manages the medical claims for radiology. Always confirm that your doctor has submitted the necessary clinical notes to the contractor before scheduling a high-tech scan to avoid "Point of Service" charges or claim denials.

## Related terms * **Ancillary Services:** Supplemental medical services, such as radiology or laboratory tests, that support a primary physician's diagnosis. * **Pre-authorization:** A requirement to get "prior approval" from Humana Military or TriWest before receiving certain high-tech scans like MRIs. * **Medical Necessity:** The standard used by TRICARE to determine if an imaging procedure is required for the diagnosis or treatment of a specific condition. * **Regional Contractor:** The entity (Humana Military in the East; TriWest in the West) responsible for processing radiology claims and authorizations. * **Catastrophic Cap:** The maximum out-of-pocket amount a beneficiary pays each year; radiology copays count toward this limit.

## Sources * TRICARE.mil: Covered Services - Radiology [https://www.tricare.mil/CoveredServices/IsItCovered/Radiology] * Humana Military (East Region): [https://www.humanamilitary.com/] * TriWest Healthcare Alliance (West Region): [https://www.triwest.com/]