Clinical preventive services policy update

October 20, 2021

Effective May 18, 2021, TRICARE revised the clinical preventive services policy.

The following sections of the TRICARE policy manual were revised for clinical preventive services:

Colorectal cancer screening

  • Revised coverage frequency and age limit for individuals at average risk from age 50 to age 45
  • Fecal Immunochemical Testing (FIT) of one stool sample once every 12 months beginning at age 45
  • Food and Drug Administration (FDA) approved Fecal Immunochemical Testing (FIT-DNA) stool tests (e.g. Cologuard™) once every one to three years beginning at age 45
  • Flexible sigmoidoscopy covered once every five years beginning at age 45
  • Computed Tomographic Colonography (CTC) covered once every five years beginning at age 45
  • Optical (conventional) colonoscopy covered once every 10 years beginning at age 45
  • Noted that screening guidelines are no longer specific to those with an increased risk
  • Incorporated the American Cancer Society definition of average risk
  • Removed the definition of increased risk

Lung cancer screening

  • Revised the frequency and age interval for lung cancer screening from 55 to 50 years of age
  • Pack per year history is additionally reduced from 30 to 20 packs per year

Vision screening and services

  • Revised routine eye exam language for retirees and their family members
  • Routine eye exams are not a covered benefit for retirees and eligible family members who are enrolled in TRICARE Select. Active Duty Family Members (ADFM) who are enrolled in TRICARE Select may receive a routine eye examine annually
  • Removed CPT codes 99172 - ocular function screen and 99173 - visual acuity screen from the manual

For more information, including the full definition of average risk, view TPM Chapter 7 Section 2.1