TRICARE approves coverage for LDTs to inform and support clinical decision making in the care of our beneficiaries.
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Prior authorization is required for all LDTs except for Cystic Fibrosis (CF) testing. Providers must submit a completed LDT request and attestation for prior authorization and claims payment consideration. CF testing, when part of the newborn screening panel, is handled under the global maternity authorization. For the quickest processing to approval for prior authorization, submit the request via self-service and attach the required documentation.
Please note that a completed attestation form will be accepted in lieu of supporting clinical documentation for prior authorization requests and claim payment; however, the authorizations are subject to a routine audit that will include a request to provide supporting medical documentation.
For all requests:
Given the complexity of risk assessment and test interpretation, as well as the importance of adequate medical management, genetic counseling is very valuable to any individual receiving a LDT. Genetic counseling may only be provided by TRICARE-authorized providers and must precede the actual LDT.
Beneficiaries are responsible for the appropriate copay/cost-share on lab claims processed with the approved authorization on file according to their benefit plan. Claims for genetic testing submitted without an approved authorization or LDT request and attestation form will be denied. Other Health Insurance (OHI) rules apply.
**Providers can now attach LDT attestation forms to the authorization request in provider self-service by selecting ATTESTATION FORM – LAB DEVELOPED TEST (LDT) in the drop-down menu.
For more information on the TRICARE policy, refer to the TRICARE Operations Manual: Chapter 18, Section 3