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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.

Gene Tested

Related Disease or Condition

APC Familial adenomatous polyposis
BCR/ABL1 Chronic myelogenous leukemia
BMPR1A Juvenile polyposis syndrome
BRAF Papillary thyroid carcinoma, 4800 BRAF mutation
BRCA1/BRCA2 Breast cancer, ovarian cancer
CEBPA Acute myeloid leukemia
CFTR Cystic fibrosis
Cytogenic Constitutional Microarray Analysis Genetic syndrome, autism spectrum disorder, Asperger syndrome and pervasive developmental disorder
EFGR Lung cancer
F2 Prothrombin (Factor II)-related thrombophilia
F5 Factor V Leiden thrombophilia
FMR1 Fragile X mental retardation
HBA1/HBA2 Alpha-thalassemia
HEXA Low hexosaminidase A levels
HFE Hereditary hematochromatosis
HLA Compatibility of tissue between organ and bone marrow donors and recipients, platelet transfusion and Celiac disease
JAK2 Myeloproliferative neoplasms
KRAS Anti-EGFR monoclonal antibodies
MECP2 Rett syndrome
MLH1, MSH2, MSH6, MSI, PMS2 and EPCAM Lynch syndrome
MPL Myeloproliferative leukemia
MUTYH MYH-associated polyposis
NPM1 MYH-associated polyposis
PAX8 Papillary thyroid carcinoma
PML/RARalpha Acute promyelocytic leukemia
PMP22 Hereditary polyneuropathies
PTEN Autism Spectrum Disorders and macrocephaly, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome
RET Multiple endocrine neoplasia type 2, familial medullary thyroid carcinoma
SMAD4 Juvenile polyposis syndrome
SMN1/SMN2 Spinal muscular atrophy
SNRPN/UBE3A Prader-Willi syndrome, Angelman syndrome
STK11 Puetz-Jeghers syndrome
TP53 Li-Fraumeni syndrome or Li-Fraumeni-like syndrome
TRG T-cell neoplasms
VHL Von Hippel-Lindau syndrome
Disclaimer:

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.

Last Updated 9/15/2014

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