Preventive Services Update: Colorectal and Lung Cancer Screenings, Routine Eye Exams

Monday, September 13, 2021
corrected September 15, 2021

Retroactive to August 13, 2021, and implemented on September 13, 2021, TRICARE has updated its lung and colorectal cancer screening guidelines to align with current United States Preventive Services Task Force (USPSTF) recommendations. Additionally, visual acuity and ocular screenings are no longer covered under the routine eye exam benefit. Please refer to TRICARE Policy Manual, Chapter 7, Section 2.1 for details.

Colorectal cancer screening
The minimum age for those at average risk to begin colorectal cancer screenings has been lowered from age 50 to age 45. Frequencies for specific screenings have also been updated. TRICARE covers the following screenings:

fecal occult blood test: Once every 12 months
fecal immunochemical testing (FIT): One stool sample every 12 months
FIT-DNA: FDA-approved stool DNA tests (e.g. Cologuard™) once every one to three years
flexible sigmoidoscopy: Once every five years
computed tomographic colonography: Once every five years
colonoscopy: Once every 10 years
flexible sigmoidoscopy with annual FIT: Once every 10 years

Please refer to the TRICARE Policy Manual for the current definition of “average risk.” The American Cancer Society and USPSTF no longer offer guidelines specifically for people at increased or high risk of colorectal cancer. Providers are encouraged to discuss with beneficiaries who may be at increased or high risk as to whether they need to start colorectal cancer screening before age 45, be screened more often, and/or use personalized testing strategies.

Lung cancer screening
Low-dose computed tomography is now recommended for TRICARE beneficiaries ages 50 to 80 who have a 20 pack per year history of smoking and are currently smoking or have quit within the past 15 years.

Routine eye exams
TRICARE no longer covers routine eye exams for Common Procedural Terminology (CPT®) codes 99172 (ocular function screening) and 99173 (visual acuity screening).

Please visit the Benefits A–Z for information on the above-listed benefits.