TRICARE Benefit Expands to Cover New Hip Surgery

By: TRICARE
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Falls Church, Va, December 4, 2015 - The 2015 National Defense Authorization Act created a provisional coverage program that allows TRICARE to provide coverage for emerging treatments and technologies. The first treatment to be evaluated and approved under this new program is surgical treatment of a hip condition called Femoroacetabular Impingement (FAI).  FAI can occur when the bones of the hip are abnormally shaped. Because they do not fit together perfectly, the hip bones rub against each other and cause damage to the joint.  Symptoms include pain in the hip or groin area which limits or hinders mobility.

Provisional coverage for FAI surgery begins January 01, 2016. At that time, your health care provider can give you a referral for treatment if you are diagnosed with this condition and meet certain clinical criteria. You will be able to get FAI surgery from any TRICARE authorized orthopedic surgeon who performs this procedure. Your costs will vary by plan, but will be lower if you use a network provider. The surgery must be pre-authorized by your regional contractor. Pre-authorization lets your provider present additional information so TRICARE and our contract partners can make an individual review of your care.   There is no retroactive preauthorization or coverage prior to January 01, 2016.

The American Orthopaedic Society for Sports Medicine reports that some people may have FAI their entire lives, and never have any problems. However, if symptoms develop, it usually means there is damage to the cartilage and the condition is likely to get worse.  

"TRICARE can now review emerging health care products and services that are not currently covered under the TRICARE program but may provide a benefit to patients under a provisional coverage status." said Dr. James Black, Medical Director, Clinical Support Division, Defense Health Agency. "We will evaluate other emerging treatments and technologies for consideration and make public announcements when additional ones are approved."

For more information about TRICARE and the provisional coverage program, visit the TRICARE website.