Is It Covered?
Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.
Laboratory Developed Tests
Laboratory developed tests:
- Assess risk or help guide treatment of certain medical conditions or rare diseases
- Are developed by clinical laboratories that offer tests to the public, but don't sell them to other labs
- Aren’t usually covered by TRICARE until approved by the U.S. Food and Drug Administration (FDA)
The Laboratory Developed Tests Demonstration Project:
- Allows TRICARE to review tests not examined by the FDA to determine if they’re safe and effective
- Gives you access to laboratory developed tests not usually covered
- Includes coverage for prenatal and preconception cystic fibrosis carrier screening with some limitations.
- Is a three-year demonstration that will end on July 18, 2017
How does it work?
Referral and authorization guidelines are in development now. We’ll add details to this page about how referrals and authorizations will work, so please check back or sign up to get updates via email. You can talk to your doctor and regional contractor to see if you qualify for any of the tests covered by the demonstration.
Here’s what you need to know:
- You must meet your test’s coverage guidelines (see the chart below)
- You must get prior authorization from your regional contractor for all covered tests, except the cystic fibrosis screening
- Accredited clinical laboratories must do your tests
- You can't appeal denials under the demonstration
What tests are included in the Demonstration?
The tests below are in this demonstration. We will add new tests as they get approved for coverage.
If you’ve paid for any of the tests listed here since January 1, 2013, you may get retroactive reimbursement. We’ll add details to this page about how to get retroactive payments, so please check back.
Related Disease or Condition
||Familial adenomatous polyposis
||Chronic myelogenous leukemia
||Juvenile polyposis syndrome
||Papillary thyroid carcinoma, 4800 BRAF mutation
||Breast cancer, ovarian cancer
||Acute myeloid leukemia
|Cytogenic Constitutional Microarray Analysis
||Genetic syndrome, autism spectrum disorder, Asperger syndrome and pervasive developmental disorder
||Prothrombin (Factor II)-related thrombophilia
||Factor V Leiden thrombophilia
||Fragile X mental retardation
||Low hexosaminidase A levels
||Compatibility of tissue between organ and bone marrow donors and recipients, platelet transfusion and Celiac disease
||Anti-EGFR monoclonal antibodies
|MLH1, MSH2, MSH6, MSI, PMS2 and EPCAM
||Papillary thyroid carcinoma
||Acute promyelocytic leukemia
||Autism Spectrum Disorders and macrocephaly, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome
||Multiple endocrine neoplasia type 2, familial medullary thyroid carcinoma
||Juvenile polyposis syndrome
||Spinal muscular atrophy
||Prader-Willi syndrome, Angelman syndrome
||Li-Fraumeni syndrome or Li-Fraumeni-like syndrome
||Von Hippel-Lindau syndrome
This A-Z list of topics is not all inclusive. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all.