TRICARE Moves BRCA Testing to No Government Pay Procedure Code List

TRICARE has determined that they will not allow payment for BRCA testing. The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes - BRCA1 and BRCA2. As a result of this directive, TMA added all BRCA lab test codes to the No Government Pay Procedure Code List effective January 1, 2012. Previously, TriWest paid the BRCA codes without prior authorization. With this change, TriWest must deny all claims submitted for this procedure with dates of service January 1, 2012 or later.

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