Back to Top Skip to main content the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Policy Manual 6010.63-M, April 2021
Chapter 1
Section 7.1
Primary Care Managers (PCMs)
Issue Date:  May 15, 1996
Authority:  32 CFR 199.17
1.0  Policy
1.1  TRICARE Prime enrollees shall select or have assigned to them PCMs according to guidelines established by the Market Director/Military Medical Treatment Facility (MTF) Director, or other Government Designated Authority (GDA).
1.1.1  A PCM may be a network provider, or a Market/MTF PCM by name/supported by a team. If a group practice is listed as a network provider, the contractor shall ensure all members of the group practice are TRICARE-authorized providers.
1.1.2  The Defense Health Agency (DHA) considers the following types of individual professional providers as primary care providers and the contractor shall designate them as PCMs, consistent with governing State rules and regulations: internists, family practitioners, pediatricians, General Practitioners (GPs), obstetricians/gynecologists (OB/GYNs), Physician Assistants (PAs), Nurse Practitioners (NPs), and Certified Nurse Midwives (CNMs).
1.2  A TRICARE Prime enrollee must seek all his or her primary health care from the PCM with the exception of Clinical Preventive Services. If the PCM is unable to provide a primary care service, the PCM is responsible for referring the enrollee to another primary care provider. The contractor shall ensure PCMs refer TRICARE Prime enrollees for specialty care or for inpatient care. For mental health and Substance Use Disorder (SUD) care, all inpatient and outpatient services, except office-based, outpatient treatment provided by a network provider, require a referral. However, if the non-office based, outpatient mental health or SUD provider is a network provider, the contractor may accept a request for preauthorization from the network provider in lieu of PCM referral. If the enrollee fails to obtain a PCM referral when one is required, the contractor shall pay for the service under Point of Service (POS) procedures with a deductible for outpatient services and cost-shares for in- and outpatient services.
1.3  The contractor shall ensure the PCM notifies the contractor that a referral is being made. The contractor shall assist the TRICARE Prime enrollee in locating a Market/MTF or network provider to provide the specialty care and in scheduling an appointment.
1.4  The contractor shall conduct a prospective review and authorize the service in accordance with the contractor’s best practices.
PCM referral is not required for the following services:
2.1  Services provided directly by the PCM.
2.2  Emergency care.
2.3  Services provided as part of the comprehensive clinical prevention program offered to Prime enrollees.
2.4  Outpatient, office-based, mental health and SUD visits.
2.5  Physical Therapy/Occupational Therapy (PT/OT) services referred by a network podiatrist as set forth in Chapter 8, Section 11.1, paragraph 2.5.
- END -

Utility Navigation Links

DoD Seal is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.


DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.