COVID-19 Testing
COVID-19 testing is a covered benefit when medically necessary and ordered by a TRICARE-authorized provider. Beneficiaries suspected to have COVID-19 should be tested following Centers for Disease Control and Prevention (CDC) guidelines. Tests must meet Families First Coronavirus Response Act (FFCRA) criteria.
Testing required prior to a procedure or admission may be considered medically necessary and appropriate.
FDA-approved at-home antigen rapid diagnostic test kits may be covered with a physician's order.
Visit TRICARE’s Coronavirus Testing Coverage page for benefit details based on beneficiary category (for example, active duty, retired, etc.).
Diagnostic Testing
Diagnostic testing is covered when medically necessary.
Testing for asymptomatic active duty service members may be considered for coverage under the Supplemental Health Care Program.
Antibody (Serology) Testing
To be considered for coverage, antibody tests must be rendered to diagnose and/or treat beneficiaries. Antibody tests are not a covered benefit when performed:
- on asymptomatic patients;
- to satisfy patient curiosity;
- to determine a patient's ability to return to work or school;
- to determine a donor’s ability to donate blood or plasma; and/or
- as part of epidemiological research, surveillance studies or for other public health reason.
If requesting a benefit review for an antibody (serology) test, providers may attach a Letter of Attestation in lieu of clinical documentation to the request.
Approval Requirements
There are no approval requirements specific to testing from Health Net Federal Services, LLC. There are no utilization limits for how often a test can be provided, however it must be medically necessary and appropriate as indicated above.
Reimbursement
Our claims system is updated regularly to include added Current Procedural Terminology (CPT®) and Common Procedure Coding System (HCPCS) codes. Claims may be delayed to allow for appropriate code approval and system updates.
Beneficiary Copayments/Cost-Shares
The Health and Human Services' Public Health Emergency ended May 11, 2023. As a result, beneficiary copayments/cost-shares for COVID-19 testing are no longer waived.
