Laboratory and x-ray services are covered benefits. If these services are performed by the office visit provider on a date different from the office visit or performed by a different provider such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit) the beneficiary will owe a separate copayment. However, no copayment applies when provided as preventive services.
A laboratory developed test (LDT) is a diagnostic test that is designed, manufactured and used within a single laboratory. In order for an LDT to be considered for coverage certain criteria must be met. More >>
TRICARE covers lactation or breastfeeding counseling for up to six individual outpatient counseling sessions per birth or adoption when provided as a preventive service separate from an inpatient maternity stay, follow-up outpatient visit or well-child care visit.
An approval from Health Net Federal Services, LLC is not required.
Counseling services are not a covered benefit when provided by an International Board Certified Lactation Consultant® or Certified Lactation Counselor® unless that provider is also a TRICARE-authorized doctor, physician assistant, nurse practitioner, nurse midwife, or registered nurse.
Not a covered benefit, except to relieve astigmatism following a corneal transplant. See alternative resources.
Not a covered benefit; this includes therapy and treatment for a learning disability, such as dyslexia.
Lithotripsy, also known Extracorporeal Shock Wave Therapy (ESWT), is a covered benefit for the treatment of kidney stones. High Energy ESWT is a covered benefit for the treatment of plantar fasciitis when the beneficiary has chronic plantar fasciitis lasting at least six months and has undergone and failed six months of conservative therapy. It is not a covered benefit for treatment of other musculoskeletal disorders.
Long-Term Acute Care (LTAC) is a limited benefit covered only in certain circumstances such as when the beneficiary is ventilator-dependent, but has the potential of breathing independently or requires complex wound care. Prior authorization is not required except for active duty service members. However, notification of inpatient facility admissions and discharge dates are required for all TRICARE Prime beneficiaries. See prior authorization requirements for additional information.
Lung cancer screening with low-dose computed tomography is covered every year from age 55 to 80 for TRICARE Prime beneficiaries with a history of smoking 30 packs per year who are currently smoking or have quit within the past 15 years. Screening is not covered once the beneficiary has quit smoking for 15 years or develops a health problem significantly limiting either life expectancy, or ability or willingness to undergo curative lung surgery.
Luxury/convenience equipment or services are not a covered benefit; such as positioning wedges or pillows, flat free inserts for wheelchair tires and backpacks.