An active duty Navy elective surgery request starts with your primary care manager at a military treatment facility, moves through a surgical specialty consult, requires written approval from your commanding officer, and ends with the facility’s surgical department scheduling the procedure. No elective procedure is booked without all three pieces in place: the medical justification, the command endorsement, and a confirmed slot from the surgical scheduling team.
Start With Your Primary Care Manager
Bring the concern to your PCM at the military treatment facility where you receive care. If the PCM agrees a surgical option is medically appropriate, they refer you to the relevant surgical specialty clinic. The surgeon evaluates your condition at that consult, discusses the procedure with you, and, if surgery is warranted, documents the clinical justification — the reason the procedure benefits your health or readiness even though it is not an emergency. The surgeon’s note will identify the planned procedure by its Current Procedural Terminology code.
Which form you complete depends on the facility and the procedure. The surgical clinic or the facility’s elective surgery coordinator provides the correct request form for most procedures. Refractive eye surgery is the exception: PRK and LASIK requests use NAVMED 6490/1, the Navy Warfighter Refractive Surgery Consult, available at military treatment facility optometry departments and refractive surgery centers.1TRICARE. BUMEDINST 6490.1 Some commands also require a counseling entry on an SF 601 or Page 13 for non-emergency medical care sought without prior approval.2Naval Medical Center San Diego. Naval Medical Center San Diego – FAQs
Get Written Command Approval
Every active duty member needs written approval from the commanding officer before an elective procedure is scheduled. That is typically the battalion or squadron commander at O-5 or above. The CO reviews the request after considering the unit medical officer’s professional recommendation and the unit’s mission requirements, weighing whether your absence for surgery and recovery would conflict with deployments or other operational commitments.3United States Marine Corps. II MEFO 6320.4
The unit medical officer advises the CO on medical necessity, risks and benefits, and the expected recovery timeline.3United States Marine Corps. II MEFO 6320.4 Timing matters. An elective procedure generally should not be initiated if the course of treatment cannot be completed before an approved separation or retirement date, and it should not be started after a medical evaluation board report has been submitted to the Physical Evaluation Board.
Reservists on recall orders face a stricter chain. You need sign-off from your supported command’s CO, PERS-92, and NAVPERSCOM’s Medical Benefits Division (PERS-95) before beginning any elective treatment, and the surgery plus any restricted-duty recovery must finish before your recall orders end.4MyNavy HR. MILPERSMAN 1326-040
Facility Review and Scheduling
Once the CO endorses the request, the completed package goes to the military treatment facility’s surgical department or elective surgery coordinator. The facility checks operating room availability, anesthesia support, surgical staff, and post-operative care beds. Elective cases are balanced against urgent and emergency surgical demand, and active duty members generally receive scheduling priority over other beneficiary categories because keeping the active force ready is the system’s primary mission. When a slot opens, the surgical clinic contacts you to confirm the date and begin pre-operative testing: lab work, imaging, anesthesia consultation, and any other evaluations the surgeon requires.
Active duty members enrolled in TRICARE Prime pay nothing out of pocket for elective surgery performed at a military treatment facility.5TRICARE. TRICARE Prime
If the Military Facility Cannot Perform the Surgery
When the military treatment facility lacks the specialty, equipment, or capacity for your procedure, your PCM can refer you to a civilian provider through TRICARE. Active duty members need a referral for most care received outside the assigned military hospital or clinic. Your PCM coordinates the referral with the TRICARE regional contractor, which reviews it and, if the service is medically necessary and covered, issues a pre-authorization confirming coverage before the procedure.6TRICARE. Referrals and Pre-Authorizations
In some cases the TRICARE Specified Authorization Staff decides the military hospital or clinic should handle the condition after all and redirects the care back to the facility. If that happens, the regional contractor notifies you and explains how to make the appointment.6TRICARE. Referrals and Pre-Authorizations
One warning worth taking seriously: if you get civilian care that requires a referral without securing one first, you pay the bill.7TRICARE. Referrals and Pre-authorizations Members who fail to obtain prior approval for non-emergency civilian care are personally responsible for those costs.3United States Marine Corps. II MEFO 6320.4
Extra Rules for Refractive Eye Surgery
PRK and LASIK have eligibility criteria beyond the standard command-approval process. You must have at least 12 months of active duty remaining after the surgery date. You cannot be on temporary limited duty, awaiting a medical evaluation board, or anticipating separation or retirement within a year of the procedure.1TRICARE. BUMEDINST 6490.1
The request uses NAVMED 6490/1, and your line commander (not the medical department) prioritizes candidates, consistent with the program’s purpose of enhancing operational readiness and combat performance.1TRICARE. BUMEDINST 6490.1 You cannot seek refractive surgery at a civilian center without command approval, and you cannot accept free surgery from a civilian surgeon; the military treats that as an improper gift under Department of Defense regulations.
Convalescent Leave and Return to Duty
After elective surgery, your CO can grant convalescent leave — time off duty for recovery — for up to 30 days per period of hospitalization, based on the attending physician’s recommendation. Convalescent leave does not count against your regular leave balance.8MyNavy HR. MILPERSMAN 1050-180 Anything beyond 30 days needs Secretary of the Navy approval, which can be delegated to an O-5 or civilian equivalent.9Department of Defense. DoDI 1327.06
If you need more time before returning to full duty, your provider can place you on light duty in periods of up to 30 days at a time. Consecutive light duty for a single condition can run up to 90 days total, including any convalescent leave, and requires frequent provider check-ins. Recoveries beyond 90 days move to temporary limited duty, which requires an Abbreviated Medical Evaluation Board Report on NAVMED 6100/5. Temporary limited duty can last up to 12 months of non-deployability unless NAVPERSCOM (PERS-454) approves an extension.10TRICARE. Limited Duty Once the condition resolves, a provider can return you to full duty at any time using NAVMED 6100/6.
If Your Request Is Denied
A request can be turned down in two places. Your CO can disapprove it based on mission requirements, or the facility can decline to schedule it based on capacity or medical criteria. When the CO disapproves, your options run through your chain of command; you can ask for reconsideration when the operational picture changes, such as after a deployment or during a training lull.
If the denial comes from a TRICARE pre-authorization decision, such as a regional contractor finding that the procedure is not medically necessary, a formal appeal path exists. Send an appeal letter to your regional contractor within 90 days of the decision with the explanation of benefits and supporting medical documentation. If that appeal is denied, you can request reconsideration from the TRICARE Quality Monitoring Contractor within 90 days. For disputed amounts of $300 or more, an independent hearing through the Defense Health Agency is available within 60 days of the formal review decision.11TRICARE. Medical Necessity Appeals