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Promote Wellness through Preventive Care (Article 3) |
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TRICARE coverage includes a robust preventive benefit that can detect health risks before they become serious health problems. Encourage your patients to take advantage of their clinical preventive health care services offered through TRICARE, and become familiar with the differences in coverage between TRICARE Prime, TRICARE Standard and TRICARE Extra.
TRICARE clinical preventive services include immunizations; patient and parent education/counseling services; infectious disease screening; cardiovascular screenings; hearing (exams, evaluations, screenings); well-child care; and cancer screenings, including mammograms, routine Pap Smears, colonoscopy, fecal occult blood testing, proctosigmoidoscopy or sigmoidoscopy, and skin cancer.
Note: Annual sports physicals are not a covered benefit under TRICARE.
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TRICARE Prime Coverage |
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TRICARE Prime offers enhanced vision coverage and TRICARE Prime enrollees* do not require a referral or prior authorization for clinical preventive services. Additionally, they do not pay a copayment when care is received from a TRICARE network provider. |
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*Active duty service members (ADSMs) must have a referral and prior authorization before receiving clinical preventive services. |
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TRICARE Standard Coverage |
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While TRICARE Standard and TRICARE Extra beneficiaries can enjoy many of the same services as TRICARE Prime beneficiaries, vision coverage is not included. TRICARE Standard beneficiaries may have clinical preventive services performed by a network or certified non-network provider and are required to pay the applicable cost-share and deductible for the care provided. You have the power to identify potential health risks before they become serious health problems, enabling beneficiaries to live longer, healthier lives. For more information about covered clinical preventive services, please call Humana Military at 1-800-444-5445.
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Clinical Preventive Services* Health Promotion and Disease Prevention Examination CPT Codes
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| 45300–45339 |
Proctosigmoidoscopy or sigmoidoscopy |
| 45355–45385 |
Colonoscopy; colonoscopy with removal of polyps, tumors etc. |
| 76092 |
Screening mammography; bilateral two view film study of each breast |
| 80061 |
Lipid panel including the following: cholesterol, serum, total (82465); lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718); triglycerides (84478) |
| 82270 |
Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations |
| 82274 |
Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations |
| 84153 |
Prostate specific antigen (PSA) |
| 86580 |
Skin test; tuberculosis, intradermal |
| 86585 |
Skin test; tuberculosis, tine test |
| 86762 |
Antibody, rubella |
| 87340 |
Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi-quantitative, multiple step method; hepatitis B surface antigen (HBsAg) |
| 88141–88155 |
Cytopathology lab procedure for screening Pap tests |
| 88160–88162 |
Cytopathology, smears and any other source; screening and interpretation |
| 88164–88167 |
Cytopathology lab procedure for screening Pap tests |
| 90281–90396 |
Immune globulin |
| 99172 |
Visual function screening; automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates and field of vision |
| 99173 |
Screening test for visual acuity, quantitative, bilateral |
| 99201–99215 |
Office or other outpatient visit of new or established patient which requires three key components: problem focused history; problem focused examination; medical decision making, counseling and coordination of care |
| 99381–99387 |
Comprehensive health promotion and disease prevention exam office visit |
| 99391–99397 |
Comprehensive health promotion and disease prevention exam office visit |
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* For a complete listing of clinical preventive services, see the Medical Coverage chapter of your TRICARE Provider Handbook. |
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