On 1 January 2013, TRICARE placed several Molecular Pathology (MoPath) Laboratory tests on the No Government Pay Procedure Code List (NGPPCL) and discontinued reimbursement for these Laboratory Developed Tests (LDTs) for TRICARE patients. The LDTs that were placed on the NGPPCL include MoPath tests frequently used to test for diseases or conditions, including those that may develop during pregnancy (Cystic Fibrosis, Fragile X syndrome, and spinal muscular atrophy).

According to TRICARE, certain LDTs may still be covered for TRICARE beneficiaries who use a Military Treatment Facility (MTF). In most cases, those same LDTs will no longer be covered for TRICARE beneficiaries who do not have access to a MTF and who use a civilian medical provider. We are concerned that TRICARE's decision will jeopardize patient access to LDTs and ultimately create two levels of care within the military health system and the TRICARE network: one that discriminates against beneficiaries with limited access or those unable to access a MTF.

We are concerned that TRICARE's refusal of coverage and reimbursement for certain LDTs outside of a MTF denies Guard military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a MTF.

TASK FORCE RECOMMENDATION: CONCUR

NGB RECOMMENDATION: No comment