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News | Aug. 23, 2023

TRICARE Laboratory Developed Tests Demonstration Extended, Certain Tests Now Covered

By TRICARE Communications

The Defense Health Agency (DHA) announced the five-year extension of the Laboratory Developed Tests (LDTs) Demonstration. The DHA extended the demonstration from July 19, 2023 through July 18, 2028. This means that if you have TRICARE, you’ll continue to have access to certain LDTs that aren’t approved by the Food and Drug Administration.
 
The DHA also announced that TRICARE will now cover several preconception and prenatal carrier screenings that were previously offered through the demonstration as part of the basic TRICARE benefit.
 
“Preconception and prenatal carrier screenings help identify people at risk for having children with genetic conditions that may have a high level of death or a shortened life expectancy,” said LaChanda Black, a management and program analyst with TRICARE Health Plan’s Member Benefits and Reimbursement Section. “Providing families access to these screenings can help them make decisions when planning their family.”
 
The lab tests that moved from the LDT demonstration to being a TRICARE covered medical benefit include one test per condition per lifetime for these specific conditions:
  • Cystic fibrosis
  • Spinal muscular atrophy
  • Fragile X syndrome
  • Tay-Sachs disease
  • Hemoglobinopathies
  • Conditions linked with Ashkenazi Jewish descent
 
TRICARE retroactively approved these tests as covered screenings back to Dec. 27, 2021. If you received one of these carrier screening tests and paid out-of-pocket costs between Dec. 27, 2021 and the new policy start date of July 19, 2023, call your TRICARE regional contractor. Your regional contractor will walk you through how to submit a claim. You can also request that TRICARE reprocess a denied claim.
 
If you don’t know how the claims process works, you can review step-by-step instructions for how to file medical claims. Be sure to follow these steps for easy claims filing:
  1. Fill out and sign the Patient’s Request for Medical Payment (DD Form 2642).  
  2. Include a copy of the provider’s bill and related charges paid. You’ll also need the sponsor’s Social Security number; provider’s address and phone number; date, location, and description of service; and diagnosis, if isn’t on the bill.
  3. Mail your claim form to the claims address for your claims processor.
  4. If you’re filing an overseas claim, you can file your claim online.
  5. Register on your claims processor’s website to keep track of your claims online.
  6. If you have questions, reach out to your regional contractor.
 
You can also go to tricare.mil/comparecosts to look up detailed costs and fees. For additional cost and fee information related to your health plan, review the TRICARE Costs and Fees Fact Sheet. For more information about LDTs, you can go to Laboratory Developed Tests.
 
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.  
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