Adjunctive dental care is medically necessary dental care that is:
- for the treatment of an otherwise covered medical (not dental) condition,
- an integral part of the treatment of such medical condition or
- required in preparation for, or as the result of, dental trauma which may be or is caused by medically necessary treatment of an injury or disease.
- Removal of teeth and tooth fragments to repair a fractured jaw
- Tooth restoration if the trauma was directly related to treating a covered medical condition
- Complete ankyloglossia (tongue-tie) to alleviate difficulty swallowing or speaking (Partial ankyloglossia is not covered.)
- Dental care directly related to surgical correction of a severe congenital anomaly
- Dental care in preparation for, or as a result of, radiation therapy for oral or facial cancer
- Anesthesia and facility fees to safeguard the life of the patient (see below)
Regular dental benefits are available under the separate TRICARE dental programs.
Dental Anesthesia and Facility Benefits
Patients with life-threatening medical conditions (such as hemophilia)
Facility services and supplies for routine dental services are covered to safeguard the life of the patient. Professional (non-facility) dental services and anesthesiology are not covered.
Children ages five and younger/beneficiaries with severe disabilities
Facility services and supplies, and anesthesia administered by an anesthesiologist, are covered for routine dental services.
The following services are not covered:
- Anesthesia administered at the facility by an attending dentist
- Professional dental services
- Anesthesia administered in a dentist office
Prior authorization is required except for beneficiaries who have other health insurance or when the adjunctive dental care is due to a medical emergency. TRICARE Prime beneficiaries do not require a separate referral from their primary care manager.
When requesting approval for dental anesthesia, treating dentists should include clinical documentation that specifies the medical condition requiring its use to expedite the authorization process.
Where the services are provided determine the beneficiary’s cost: ambulatory surgery center or inpatient hospital setting.
The TRICARE medical benefit does not cover routine, preventive, restorative, emergency, prosthodontic, or periodontic dental care that is not related to a medical condition. Exclusion examples:
- Treatment of dental caries and periodontal disease
- Emergency room visits for dental pain
- Tooth extraction, including impacted wisdom teeth
- Provision of implants, crowns, dentures, and bridges
- Accidental injury to the teeth alone. For example: The removal of broken teeth to treat a fractured jaw due to a car accident is a covered because the care is related to a medical condition (the fractured jaw). However, if the car accident only caused damage to the teeth and they need to be removed, the care is not covered by the TRICARE medical benefit.