TRICARE referrals and authorizations
Last reviewed
Referrals are where TRICARE turns expensive by accident. The rules aren't complicated, but they're different for active duty than for everyone else, and the penalty for getting them wrong lands on you rather than on the provider who didn't ask.
Referral or authorization? They're not the same thing
- A referral is your primary care manager sending you to someone else — usually a specialist. It's about who you see.
- A pre-authorization is your regional contractor approving a specific service before it happens. It's about what is done, and it can apply even when no referral is needed.
You can need one, both or neither. On Select you rarely need a referral but may still need an authorization for certain services.
Who needs a referral for what
| If you are… | Routine specialty care | Urgent care | Emergency care |
|---|---|---|---|
| An active duty service member on Prime | Referral required for anything your PCM doesn't provide | Referral required — via your military clinic or the Nurse Advice Line | None. Go. |
| An active duty family member on Prime | Referral generally required | No referral | None |
| A retiree or family member on Prime | Referral generally required | No referral | None |
| On TRICARE Prime Remote | Referral generally required for specialty care | No referral | None |
| On TRICARE Select | No referral — but some services still need authorization | No referral | None |
Sources: tricare.mil referrals and pre-authorization and its urgent care page, verified August 1, 2026. Where the two pages differ on Prime Remote urgent care, the urgent care page is explicit that no referral is needed, and we follow it.
Emergencies never need prior approval. Not on any plan, not for anyone. If it's an emergency — chest pain, difficulty breathing, severe bleeding, a head injury — call 911 or go to the nearest emergency room. Do not spend a second looking for a referral. Follow-up notification rules exist, but they happen after you're safe.
Active duty: the strictest rules, and why
If you're an active duty service member, your care is a readiness matter as much as a benefit, and the system keeps a tighter hold on it. You go to your assigned military hospital or clinic first. For civilian care — including urgent care — you need a referral from your primary care manager, and after you're seen you're expected to call your PCM the next duty day.
You also cannot use the point-of-service option. For other beneficiaries, going outside the rules on Prime means paying more; for active duty members that escape hatch doesn't exist, which is why the referral genuinely matters rather than being paperwork.
Away from your duty station and something's wrong? Call the Nurse Advice Line at 800-TRICARE (800-874-2273), option 1, or your regional contractor. They can start the referral rather than leaving you to guess.
The point-of-service option, and what it costs
If you're on Prime and you see a provider without the referral you needed, you haven't lost your coverage — you've triggered the point-of-service option. TRICARE still pays something, but you pay a separate deductible and a much larger share of the bill, and those charges don't count toward your catastrophic cap the way normal cost shares do.
In practice: one specialist visit you were entitled to, taken without the referral you were entitled to get, can cost several times what it should have. The referral is usually a phone call.
How to actually get one
- Ask your primary care manager. Everything starts there if you're on Prime.
- Your PCM sends it to your regional contractor — Humana Military in the East, TriWest Healthcare Alliance in the West — who processes it and routes you, generally to a military facility first where one can take you.
- Wait for the authorization letter before you book. It names the provider, the number of visits and the window. Book outside that and you're back to point-of-service.
- Watch the expiry. Referrals run out. If your specialist wants to keep seeing you past the approved visits, someone has to request an extension — and it's worth confirming that happened rather than assuming.
You can track referrals and authorizations in your regional contractor's secure portal, which is faster than calling: East · West.
After a move, re-check everything
A referral approved in one region does not carry into the other. If you PCS across the East/West line mid-treatment, your open referrals need re-issuing by the new contractor — and this is the single most common way ongoing specialty care gets interrupted. See the region guide for the full moving checklist.
Related: Urgent care rules and costs · Finding a doctor · Plans explained
TRICARE benefit rules change on contract cycles and at the turn of each calendar year. This guide was checked against tricare.mil on August 1, 2026. If something here doesn't match what your regional contractor tells you, they're right and we want to know — use the form below.