Tricare Prime Question... — The Bump
Military Families

Tricare Prime Question...

I am not sure if this has been asked or not but is anyone else on Tricare Prime being charged for their 20 week ultrasound? Tricare keeps saying they do not cover routine ultrasounds but I was under the impression (since this is my third birth but my first at a civilian provider) that a 20 week ultrasound was pretty standard in maternity care to determine any issues with the fetus...Has anyone else had this problem or am I just missing something here? They are also refusing to cover the follow-up u/s that was required because they could not detect four chambers in LO's heart. Thanks in advance.

Re: Tricare Prime Question...

  • The twenty week ultrasound should be covered. It is considered to be a routine part of care for diagnostic reasons. If you had a follow up, it should be covered as well. I would see how it was coded. If it wasn't coded properly, then they might try to deny it.
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  • I have an appointment tomorrow so I will be speaking with my doctor. The office has submitted the codes multiple times but apparently are submitting incorrect ones. We have been going back and forth since October. Needless to say, this is adding a little stress at the end of this pregnancy. I am guessing it will get worked out in the end, it is just hard to go to when you feel like you get the run-a-round from Tricare and the doctors office. *sigh* Only a few weeks left and I can go back to only seeing my PCM ( which with soon to be 4 kids will only be when absolutely necessary lol). Thanks for helping to settle my nerves a little.
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  • It must be a coding issue.  I saw a civilian doctor on Prime while pregnant with DD.  I can't even count the number of ultrasounds I had and every one was covered.  With this pregnancy, I am on Standard.  I've had a few billing issues, but all of my ultrasounds have been covered, including those that my OB referred out to a high risk doctor. 

    I feel the same way regarding the "run around".  Tricare blames the coding but won't tell me what the code should be and the doctor's office blames Tricare.  I'm not trained in medical billing and CPT codes so it's like banging my head against the wall.  I know for a few of my billing issues, the doctor's office coded the individual procedures correctly, but did not code the overall visit as maternity.  Tricare didn't bother to look any further than the visit code and billed me. 

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  • I have Tricare Prime & I was told by Tricare that the confirmation of conception us (8 weeks) & the anatomy check us (20 weeks) are the only 2 that are authorized & will be covered. My doctor did way more than that but I was never charged for those either. Talk to your OB's office manager & find out what they are coding your visit as & what they need to change it to for it to be covered. GL.

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