Fig. 8.1

Preventive
Care Services

Proper
V Codes

Corresponding
CPT Codes

Care Intervals
and Notes

Colonoscopy

Proctosigmoidoscopy/sigmoidoscopy once every 10 years (beginning at age 50).

Colonoscopy once every two years beginning at age 25 or five years younger than the earliest age of diagnosis for colon rectal cancer in an affected relative; then annually after age 40 for people with hereditary non-polyposis colon rectal cancer syndrome.

Colonoscopy should be performed every three to five years, beginning 10 years earlier than the youngest affected relative with sporadic colon rectal cancer.

There is no copayment required for TRICARE Prime beneficiaries. Applicable cost-shares and deductibles apply to TRICARE Standard and TRICARE Extra beneficiaries.

Mammograms

V70.0
V70.5
V70.9

Performed annually for women over the age of 39 (Baseline at age 35 for high risk, then annually).

There is no copayment for TRICARE Prime beneficiaries. Applicable cost-shares and deductibles apply to TRICARE Standard and TRICARE Extra beneficiaries.

V72.0

92002
92004
92012
92014
92015
99172
99173

Active Duty Service Members (ADSMs) and Active Duty Family Members (ADFMs)
One routine eye exam to check for vision per calendar year.

• If enrolled in TRICARE Prime, every other year will include a preventive exam to check for diseases.
• ADFMs using TRICARE Standard and Extra or TRICARE For Life will only receive a routine eye exam annually to check for vision.
• Medically necessary care for injuries to the eye is covered.

Retired Service Members and Their Families (includes all other beneficiaries besides ADSMs and ADFMs)

• If enrolled in TRICARE Prime, one comprehensive eye exam to check for vision and diseases every two years (except for diabetic patients, see below).
• If using TRICARE Standard and Extra or TRICARE For Life, no coverage (except for well-child benefit and diabetic patients, see below).
• Medically necessary care for injuries to the eye is covered.

Well-Child Benefit
For all TRICARE-eligible infants and children up to age 6

• Infants may receive one eye and vision screening¹ during routine exam at birth and at approximately 6 months of age under the well-child benefit. Use V20.2 for eye exams under the well-child benefit.
• Children may receive two pediatric comprehensive eye exams² between the ages of 3 and 6 years under the well-child benefit (use V20.2).

Diabetic Patients
Diabetic patients at any age are allowed one routine eye examination each calendar year.

Note: For TRICARE Prime enrollees, a PCM or Humana Military referral is not needed, but TRICARE Prime beneficiaries must see an MTF or network optometrist or ophthalmologist. The V code can be used for the annual exam; however, if a medical condition is identified, use medical diagnosis CPT codes.

Pap Smears

V72.3
V76.2

88141-88155
88164-88167
99201-99215
99301-99313

Annually for women over the age of 18 (younger if sexually active). No PCM or Humana Military referral or copayment is required for TRICARE Prime beneficiaries, but they must use a network provider.

TRICARE Standard and TRICARE Extra beneficiaries will pay the applicable cost-shares and deductibles.

Regular
Immunizations

V20.2
(includes well-child check)

90471-90474
90476-90748

School Physicals
(Note: A sports related physical exam is not a covered benefit.)

V70.0
V70.3
V70.5
V70.9

99201-99205
99211-99214
99383-99393

TRICARE-eligible dependents who are at least 5 years old and less than 12 years old may get physical exams that are required by a school in connection with the enrollment of the dependent as a student in that school. This benefit does not include physical exams that may be required by the school to participate in school sports. Children ages 12 and older are authorized only if a physical is required.

TRICARE Prime beneficiaries do not have a copayment, but they must use a network provider.

TRICARE Standard and TRICARE Extra beneficiaries will pay the applicable cost-shares and deductibles.

Well-child Visits

V20.2

Includes routine newborn care, comprehensive health promotion (birth to 6 years) and disease prevention exams, vision and hearing screenings, height/weight/head circumference, routine immunizations (according to CDC guidelines), and developmental/behavioral appraisals (according to American Academy of Pediatrics).
Copayments are not required of TRICARE Prime beneficiaries. TRICARE Standard and TRICARE Extra beneficiaries will pay the applicable cost-shares and deductibles.