TRICARE Adds Laboratory Developed Tests to Benefits
In the summer of 2023, the Defense Health Agency (DHA) announced an extension of a 2013 pilot program allowing the DoD to provide military members and their families with certain healthcare testing that fell outside FDA regulatory procedures.
TRICARE has since made its own announcement, adding coverage for some testing previously offered in the pilot program.
Related: DoD Extends Testing Program, Adds Diagnostic Tests
DHA Laboratory Developed Tests Pilot Program
The Defense Health Agency Laboratory Developed Tests pilot program included prenatal screenings for breast cancer risk, prenatal tests for cystic fibrosis, and genetic testing for rare conditions typically not covered under TRICARE because of a perception they are “not medically necessary.”
The Laboratory Developed Tests (LDT) Demonstration was extended from July 2023 to 2028. That extension originally meant those covered under TRICARE would have extended access to certain LDTs not approved by the Food and Drug Administration.
But since that extension, there have been changes in TRICARE policy, which now permit some of these LDTs to be covered under TRICARE.
New LDT Coverage Under TRICARE
TRICARE now covers several preconception and prenatal carrier screenings previously offered through the demonstration as part of the basic TRICARE benefit.
These tests have been “moved” from the auspices of the LDT program and have become TRICARE-covered options. Under TRICARE policy, you may now qualify for “one test per condition per lifetime” for the following:
- Spinal muscular atrophy
- Cystic fibrosis
- Fragile X syndrome
- Tay-Sachs disease
- Hemoglobinopathies
- Medical conditions linked with Ashkenazi Jewish descent
Retroactive TRICARE Benefits For LDTs
If you paid for one of these tests from December 27, 2021, to July 19, 2023, contact TRICARE to learn your options for being reimbursed for those tests.
A TRICARE regional contractor can help you learn how to submit a claim. If you submitted a previous TRICARE claim that was ultimately denied for these tests, request that TRICARE reprocess your claim.
Related: Ultimate TRICARE Benefits Guide
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
