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