Does TRICARE cover genetic testing?
Quick Answer
TRICARE covers genetic testing when medically necessary including BRCA for hereditary cancer risk, prenatal screening, and testing for inherited conditions. Pre-authorization is typically required. Elective or direct-to-consumer testing is not covered.
Key Takeaways
- Genetic testing is covered when medically necessary and provider-ordered
- BRCA testing and prenatal screening are commonly covered tests
- Pre-authorization is required for most genetic tests
- Direct-to-consumer tests like 23andMe are not covered
Detailed Answer
TRICARE provides coverage for genetic testing when it is medically necessary and ordered by a qualified healthcare provider as part of a diagnosis or treatment plan.
Covered Genetic Testing
- BRCA1 and BRCA2 testing for hereditary breast and ovarian cancer risk
- Prenatal genetic screening (first and second trimester)
- Amniocentesis and chorionic villus sampling (CVS) when indicated
- Carrier testing for conditions like cystic fibrosis, sickle cell disease
- Diagnostic testing for suspected genetic disorders
- Pharmacogenomic testing (how your genes affect medication response)
- Hereditary cancer syndrome panels when clinically indicated
When Testing Is Covered
- Family history of hereditary cancer or genetic condition
- Abnormal prenatal screening results
- Clinical symptoms suggesting a genetic disorder
- Provider determines testing will change treatment decisions
- Meets TRICARE clinical guidelines for genetic testing
Pre-Authorization Requirements
- Most genetic tests require pre-authorization from TRICARE
- Your ordering provider submits the authorization request
- Include clinical documentation supporting medical necessity
- Authorization must be obtained before the test is performed
- Processing typically takes 5-10 business days
What Is NOT Covered
- Direct-to-consumer genetic testing kits (23andMe, AncestryDNA, etc.)
- Genetic testing for non-medical purposes (paternity, ancestry)
- Elective genetic testing without clinical indication
- Experimental or investigational genetic tests
- Whole genome sequencing without specific medical indication
Genetic Counseling
- Covered when provided by a certified genetic counselor
- Recommended before and after certain genetic tests
- Helps interpret results and understand implications
- Available at many MTFs and through civilian network providers
Prenatal Genetic Testing
- First trimester screening (blood test and ultrasound)
- Cell-free DNA testing (NIPT) for chromosomal conditions
- Amniocentesis for higher-risk pregnancies
- Genetic counseling for abnormal results
- Covered as part of prenatal care
Costs
- Active duty: No cost
- Preventive genetic screening (like BRCA for high-risk): May be $0
- Standard copays and cost-shares apply for diagnostic testing
- Genetic counseling: Standard specialist copay
Helpful Tips
- Discuss your family health history with your provider to determine if genetic testing is appropriate
- Ensure pre-authorization is approved before having genetic testing performed
- Request genetic counseling to help you understand test results and next steps
Related TRICARE Terms
Prior Authorization(PA)
Approval required from TRICARE before receiving certain services or medications.
Preventive Care
Routine health screenings and wellness services covered at no cost by TRICARE.
Copayment
Fixed amount you pay for covered services.
Network Provider
Healthcare provider contracted with TRICARE.
Related Questions
What maternity and pregnancy services does TRICARE cover?
TRICARE covers comprehensive maternity care including prenatal visits, delivery, and postpartum care for all eligible beneficiaries.
What services does TRICARE cover?
TRICARE covers preventive care, doctor visits, hospitalization, surgery, mental health, maternity, prescriptions, and more with some requiring authorization.
What services require prior authorization?
Prior authorization is needed for many inpatient stays, some surgeries, specialty services, DME, and certain high-cost procedures regardless of plan.
How does TRICARE cover pregnancy and maternity care?
TRICARE covers comprehensive maternity care including prenatal visits, delivery, postpartum care, and newborn care at no or low cost.