TRICARE provider

TRICARE expands coverage of Laboratory Developed Tests (LDTs)

Effective October 2016, TRICARE expanded the list of Laboratory Developed Tests (LDTs). With an approved prior authorization, 25 new tests are now covered for eligible TRICARE beneficiaries. Recommendations for coverage have been added to some already covered tests and procedure codes have been updated. LDTs are highly complex tests requiring a CLIA certified laboratory to develop. TRICARE has approved coverage for these genetic tests to inform and support clinical decision-making in the care of our TRICARE beneficiaries.

For our providers, we are providing a custom LDT request form and a LDT chart. The chart incorporates the updated listing of CPT codes and auth requirements such as supporting documentation necessary for the newly added LDTs. As new tests are reviewed and approved for coverage, the chart will be updated.

IMPORTANT: Prior authorization information

Prior authorization is required for LTDs except for CF testing.  CF testing, when part of the newborn screening panel, is handled under the global maternity authorization. For the quickest processing to approval for any prior authorization, providers should submit the request via Humana Military’s secure self-service for providers portal. (Learn how to submit a new LDT request.) Providers may choose to fax the completed LDT request form to 1.877.548.1547.

For all requests:

  • Please include the coverage criteria from the LDT chart to support your request.
  • Please include complete beneficiary information, the diagnoses, the CPT codes for the requested tests and the purpose for the testing when requesting prior authorization.
  • Providers requesting one of the covered (LDTs) must use a CLIA certified laboratory
  • We suggest using our major network labs (Quest & LabCorp) to ensure availability of an appropriately licensed lab.

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 will be denied. Other Health Insurance (OHI) rules apply.

For more information on the TRICARE policy, refer to the TRICARE Operations Manual: Chapter 18, Section 3