Tricare Approved Diagnoses

Tricare has stated that they will cover cytogenetic tests (routine chromosome analysis and FISH) when they are reasonable and necessary for the diagnosis and treatment of the following diagnoses listed below. For any other diagnosis Tricare will declare cytogenetic studies to be medically unnecessary. We ask that when a provider feels that cytogenetic testing is required please verify that the patient's diagnosis is listed among the approved ICD-9 codes. If the diagnosis is not listed, please present a Non-Covered Services Waiver to the patient. Your staff will need to inform the patient of the cost of the lab tests so they may decide if they want to pay for these services out of pocket.

Many Tricare plans will not cover molecular testing or sequencing. You will need to contact Tricare to confirm if the test is a covered benefit and whether or not it requires pre-authorization.

If you have any questions or concerns feel free to contact our staff at 405-271-3589 and we will be happy to help.

ICD-9 Codes that Support Medical Necessity for Cytogenetic testing for Tricare:

204.00-204.11 Acute lymphoid leukemia

205.00-205.91 Acute myeloid leukemia

208.00-208.01 Acute leukemia of unspecified cell type

238.72 Low grade myelodysplastic syndrome lesions

238.73 High grade myelodysplastic syndrome lesions

238.74 Myelodysplastic syndrome with 5q deletion

238.75 Myelodysplastic syndrome unspecified

259.0 Delay in sexual development and puberty

288.8 Other specified disease of white blood cells

630 Hydatidiform mole

631 Other abnormal product of conception

632 Missed abortion

634.00-634.02 Abortion complicated by genital tract and pelvic infection

635.00-635.02 Legally induced abortion, complicated by genital tract and pelvic infection

646.33 Habitual aborter, antepartum condition or complication

655.10 Chromosomal abnormality in fetus; unspecified as to episode of care or not applicable

655.11 Chromosomal abnormality in fetus; delivered, with or without mention of antepartum condition

655.13 Chromosomal abnormality in fetus; antepartum condition of complication

656.40 Intrauterine death; unspecified as to episode of care or not applicable

656.41 Intrauterine death; delivered, with or without mention of antepartum condition

656.43 Intrauterine death; antepartum condition or complication

758.0-758.9 Chromosomal abnormalities

V28.0 Screening for chromosomal anomalies by amniocentesis

V29.3 Observation for suspected genetic or metabolic condition