Preconception and Prenatal Carrier Screening Tests Included in TRICARE Benefit
Monday, August 28, 2023
Preconception and prenatal carrier screening tests help identify individuals and families at risk for having children with genetic conditions associated with shortened life expectancy. TRICARE will now cover several preconception and prenatal carrier screenings that were previously offered through the Laboratory Development Tests Demonstration Project (LDT Demonstration) as part of the basic TRICARE benefit.
Covered Conditions
Retroactive to Dec. 27, 2021, TRICARE covers preconception and prenatal carrier screening under the TRICARE benefit for the following conditions:
- Cystic fibrosis
- Spinal muscular atrophy
- Fragile X syndrome
- Tay-Sachs disease
- Hemoglobinopathies
- Conditions linked with Ashkenazi Jewish descent
The TRICARE benefit will cover one test per condition throughout the beneficiary’s lifetime regardless of risk status.
Note: Refer to TRICARE Operations Manual, Chapter 18, Section 3 for the current list of LDTs covered under the LDT Demonstration. We also offer details on our Laboratory Developed Tests page.
Pre-authorization
For preconception and prenatal screening and LDTs, pre-authorization is required for most tests except cystic fibrosis. We offer specific Letters of Attestation you can attach to the request in lieu of clinical documentation. These are available through our Letters of Attestation page.
Claims Information
For services provided between Dec. 27, 2021, and Aug. 28, 2023, you or your TRICARE patient can ask HNFS to reprocess any denied claims for preconception or prenatal carrier screening tests related to the above conditions. If your patient paid out of pocket for the screening, you may submit a new claim.
