An important addition to TRICARE covered benefits did not make it into the 2007 version of the provider handbook. This addition is a NEW DENTAL ANESTHESIA Benefit effective July 1, 2007. TRICARE implemented a medical policy covering medically necessary anesthesia and facility charges associated with dental care for beneficiaries with development, mental or physical disabilities, and children ages five and under. This benefit was created for beneficiaries whose age or condition prohibits dental treatment in a safe and effective manner without the use of anesthesia. To ensure medical necessity approval, please request a referral/authorization if you are aware your TRICARE patient will require dental anesthesia for a scheduled procedure.
One of the newest features available via secured logon by provider, is the addition of prescription data by patient. This information is viewable on valid patient referrals posted in Online Provider Services.
Colonoscopy Screening Benefit Expanded The Department of Defense continues to enhance the TRICARE benefit to provide the most comprehensive and quality care to your patients. A recent TRICARE policy change will now allow coverage for one routine colonoscopy screening every 10 years for beneficiaries beginning at age 50. Screenings are also covered in the following situations:
Hereditary non-polyposis colorectal cancer syndrome
A colonoscopy should be performed every two years beginning at age 25, or five years younger than the earliest age of diagnosis of colorectal cancer, whichever is earlier. Annual screenings should then occur after age 40.
Familial risk of sporadic colorectal cancer
A colonoscopy should be performed every three to five years beginning 10 years earlier than the youngest affected relative. Familial risk means that a history of first-degree relative (such as, a father, mother or brother) under age 60 with sporadic colorectal cancer or adenomas or multiple first-degree relatives with colorectal cancer or adenomas.
Other routine colonoscopy screenings are not covered by TRICARE.
Note: If your patient is a TRICARE beneficiary and eligible for Medicare, a routine colonoscopy will most likely be covered separately by Medicare.
