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The age/gender lists represent codes that TRICARE recognizes as having age and or gender restrictions. The TRICARE contractors need to make sure their age and gender file matches what is on the list or it could result in TRICARE Encounter Data Records failing.
DHA/TRICARE no longer maintains gender restrictions as of April 1, 2024.
The age restriction list is intended to serve as a factor of consideration for contractors in the processing of TRICARE beneficiary claims. While it provides valuable information to inform decision-making, it should be considered in conjunction with standard of care, healthcare delivery guidelines, and other relevant factors and not solely relied upon as the basis for approving or denying claims.
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Last Updated: January 27, 2025