Dental benefits are available under the separate TRICARE dental programs.
Limited adjunctive dental services may be covered when related to other covered medical care.
Prior authorization is required for all beneficiaries before receiving any adjunctive dental treatment to ensure the services will be covered. The prior authorization requirement is waived only when essential adjunctive dental care involves a medical emergency, such as facial injuries resulting from a car accident.
Some of the adjunctive dental procedures TRICARE may cover include:
The following are special circumstances covered under the adjunctive dental care benefit:
Facility services required to safeguard the life of the patient – Some patients have medical conditions that could become life-threatening during routine dental procedures (for example, tooth extraction for a hemophiliac). TRICARE covers the facility services and supplies. Under this category, TRICARE does not cover the professional dental services or anesthesiology.
Children age five or younger or beneficiaries with severe disabilities – Children age five and under, and beneficiaries with severe developmental, mental or physical disabilities undergoing routine dental procedures. TRICARE covers the facility services, supplies and anesthesiology services. Under this category, TRICARE does not cover the professional dental services and anesthesiology services rendered by the attending dentist. TRICARE will cover anesthesiology services rendered by a separate anesthesiology provider.
Note: Acute anxiety, behavioral issues or extensive dental treatment do not qualify a patient for adjunctive dental care.
It is important to remember the TRICARE medical benefit does not cover routine, preventive, restorative, emergency, prosthodontic, or periodontic dental care that is not related to a medical condition. Some examples of dental care that is not covered include:
For example, the removal of broken teeth to treat a fractured jaw due to a car accident is a covered adjunctive dental care service because the care is related to a medical condition (the fractured jaw). However, care for accidental injury to the teeth alone or emergency room visits for dental pain are considered non-adjunctive dental care and are not covered by the TRICARE medical benefit.