Prenatal Screening Update Under the LDT Demonstration Project

Monday, February 12, 2024

Preconception and prenatal carrier screening tests help identify individuals and families at risk for having children with genetic conditions associated with shortened life expectancy. The following information summarizes recent changes to TRICARE’s Laboratory Developed Tests (LDT) Demonstration Project (Demonstration) coverage. 

Noninvasive Prenatal Screening for Trisomies 13, 18, 21, X, and Y

Effective Feb. 12, 2024, and retroactive to Aug. 17, 2020, pre-authorization is not required for trisomy 13, 18, 21, X, and Y tests. To be covered, testing must comply with the most recent American College of Obstetricians and Gynecologists (ACOG) guidelines. Coverage for singleton pregnancies with a high risk of fetal aneuploidy is limited to claims dated March 5, 2015, through Aug. 16, 2020. 

Refer to TRICARE Operations Manual, Chapter 18, Section 3 for LDT guidelines under the Demonstration.

Visit our Laboratory Developed Tests page or refer to our LDT Coverage Criteria Guide for more information.

Claims Information

• If a beneficiary had a trisomy 13, 18, 21, X, and Y screening test claim denied between Aug. 17, 2020, through Feb. 11, 2024, they can request that HNFS reprocess the claim. 
• If a beneficiary paid out of pocket for a trisomy 13, 18, 21, X, and Y screening test claim between Aug. 17, 2020, through Feb. 11, 2024, they can submit a claim.  

Visit our Claims page for more information on claims.