TRICARE Demonstration Project for Approved Laboratory Developed Tests (LDTs)

Effective Oct. 14, 2012, TRICARE began covering two Laboratory Developed Tests (LDTs) for eligible TRICARE beneficiaries (including Active Duty Service Members). Each genetic test is developed by a single clinical lab that provides testing directly and does not sell the lab kit to other labs. Two additional LDT tests were added to the demonstration project effective 02/22/14: Colaris for Lynch Syndrome and Colaris AP(which determine risk for other types of cancers).  LDTs are highly complex tests. TRICARE has currently approved coverage for these genetic tests to inform and support clinical decision-making and to provide surveillance of cancer treatment and services.

The LDTs currently covered are:

• BRACAnalysis® — genetic mutation testing for breast and ovarian cancer risks and as of 02/22/14 now includes the BART test if the BRACAnalysis tests are negative and the patient meets the criteria for the BRACAnalysis Large rearrangement Test (BART). The BART test is not covered as a stand alone.
• Oncotype DX® — genetic testing for breast cancer risk
• Colaris and Colaris AP

Prior Authorization Required for LDTs: Professional providers must submit a prior authorization request for the newly covered genetic testing listed above.