TRICARE Arthroplasty (Joint Replacement) prior authorization requirements (2026)
What TRICARE generally requires to approve Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118), for tricare plans. Based on the cited policy, TRICARE does not generally require prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118). Confirm with TRICARE, as this can vary by plan.
Medical-necessity criteria TRICARE generally applies
Routine total hip/knee replacement is not on the Humana mandatory PA list, but TRICARE Prime requires a referral and inpatient admission requires notification. (Hip surgery for femoroacetabular impingement does require prior authorization; hip resurfacing is covered for patients under 65 meeting criteria.) TPM Section 6.1.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Arthroplasty (Joint Replacement). Confirm the covered diagnosis list against the current TRICARE policy.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 6.1 (Musculoskeletal) · effective 2022-05-24.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-25.
Frequently asked questions
Does TRICARE require prior authorization for Arthroplasty (Joint Replacement)?
Based on the cited policy, TRICARE does not generally require prior authorization for Arthroplasty (Joint Replacement) (CPT 23470, 23472, 23473, 23474, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27702, 27091, 27488, S2118). Confirm with TRICARE, as this can vary by plan.
What does TRICARE require to approve Arthroplasty (Joint Replacement)?
Routine total hip/knee replacement is not on the Humana mandatory PA list, but TRICARE Prime requires a referral and inpatient admission requires notification. (Hip surgery for femoroacetabular impingement does require prior authorization; hip resurfacing is covered for patients under 65 meeting criteria.) TPM Section 6.1. Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Arthroplasty (Joint Replacement) to TRICARE?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.