TRICARE generally covers laboratory and X-ray services if prescribed by a physician. However, some exceptions apply (e.g., chemo-sensitivity assays, bone density X-ray studies for routine osteoporosis screening).
TRICARE’s Laboratory Developed Tests Demonstration Project allows TRICARE to review tests not evaluated by the FDA for safety and effectiveness, gives beneficiaries access to LDTs usually not covered and includes coverage for prenatal and preconception cystic fibrosis carrier screening, with some limitations.
Prior authorization is required for all LDTs except for cystic fibrosis testing, which is handled under the global maternity authorization, as part of the newborn screening panel. Providers must submit a completed LDT request and attestation for prior authorization and claims payment consideration. For the quickest processing to approval for prior authorization, providers should submit the request via provider self-service and attach the required documentation.
Note: 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 the provider for supporting medical documentation.
*Laboratories performing LDTs must have CLIA accreditation or certificate of compliance.
For additional information, visit the TRICARE Operations Manual, Chapter 18 Section 3