TRICARE Well-Child Coverage Overview

The preventive care and check-ups you as a health care professional provide from birth to age 6 can influence a child’s health for the rest of his or her life. TRICARE covers well-child care in accordance with American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) guidelines.

Well-child care is covered by TRICARE as clinical preventive care. The following is an overview:

In-hospital Newborn Care

• Circumcision – if performed after the child has been discharged from the hospital, the service is cost-shared as an outpatient service (unless it qualifies for the special cost-sharing for ambulatory surgery and the procedure is done at a hospital or free-standing ambulatory surgery center). Refer to a recent E-Newsletter article on circumcision for more information.
• AAP-recommended newborn screenings, including, but not limited to:
  • Hypothyroidism
  • Phenylketonuria
  • Hemoglobinopathies (for those in high-risk ethnic groups)
  • Galactosemia

The Department of Defense closely monitors AAP recommendations in regards to newborn metabolic screening. The AAP has endorsed a report recommending expanded metabolic screening for newborns. Additional information about the report can be found at http://mchb.hrsa.gov/screening/summary.htm and http://genes-r-us.uthscsa.edu.

Well-child Office Visits

Provide preventive care well-child visits as frequently as the AAP recommends, but no more than nine visits in two years. Visits for diagnosis or treatment of an illness or injury are covered separately under outpatient care.

The following chart shows TRICARE-covered tests and their AAP-recommended recommended frequency.

Test	Frequency
History/physical examination/mental health assessment	Each well-child visit
Height and Weight	Each well-child visit
Head Circumference	Each well-child visit through age 2
Vision Screening (by PCM)	At birth and at well-child visit at age 6 months
Comprehensive Eye Exam (by Optometrist or Ophthalmologist)	Available from birth to age six; includes eye and vision screening by a primary care manager (PCM) during a routine exam at birth and at approximately six months of age
Dental Screening	Each well-child visit
Tuberculin Test	Once at age 1; once at age 2
Hemoglobin or Hematocrit Testing	Once during first year; once during second year
Urinalysis	Once during first year; once during second year
Blood Pressure Screening	Annually between age 3 and 6

Immunizations

TRICARE covers age-appropriate doses of vaccines recommended by the CDC’s Advisory Committee on Immunization Practices. For a current schedule, refer to www.cdc.gov.

Other Tests (special criteria)

• Audiology screening (in hospital or before age 3 months only for high-risk neonates as defined by the Joint Committee on Infant Hearing)
• Blood lead test – A blood lead test (CPT code 83655) during each well-child visit from age six months to less than 6 years of age is covered by TRICARE if the assessment of risk for lead exposure is positive based on a structured questionnaire developed by the Centers for Disease Control and Prevention (CDC). For more information, please refer to an article on lead testing.
• Flu shot – All children age 6-23 months. Refer to a recent E-Newsletter article on flu shots.
• School physicals: For children ages 5 through 11 who require physicals in connection with the enrollment as a student in that school. This benefit does not include physical exams that may be required by the school solely to participate in school sports. Refer to a recent article on school physicals.

Other clinical preventive examinations or comprehensive health promotion and disease prevention exams are available for ages 24 months and older under the Clinical Preventive Services benefit.

For more information, refer to the TRICARE Web site at www.tricare.mil or call TriWest at 1-888-TRIWEST (888-874-9378).