Diagnostic testing is recommended for all participants but is mandatory if a diagnosis of AD or PDDNOS is made by a provider who is not an ASD specialist. Diagnostic testing and assessment are considered for coverage under the Basic Program.
Nonverbal and Verbal Intelligence Quotient Testing – The child’s nonverbal or verbal intelligence quotient, as measured by a standardized test of intelligence, must be obtained as a requirement for preauthorization of services after 12 months from initiating services under the Demonstration has passed. However, if testing cannot be completed after 12 months and every six months thereafter, the child’s primary care physician or ASD specialist is required to submit an Eligibility Verification certifying the beneficiary is unable to participate in intelligence testing. The beneficiary's PCP or specialized ASD provider is required to recertify the beneficiary's continued inability to participate in or complete intelligence testing every six months.
Standardized diagnostic instruments accepted by TRICARE are:
Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV)
Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition
Differential Ability Scales (DAS II)
Mullen Scales of Early Learning-AGS Edition (for children under 3 or with lower mental ages)
Leiter International Performance Scale- revised (LIPS-R)
Intelligence testing performed prior to demonstration enrollment is acceptable.
Language Skills & Adaptive Behavior Testing – Children 18 months through 8 years of age must complete standardized language skills and adaptive behavior testing. Testing must be completes within 12 months of initiating services under the demonstration. Standardized testing of language skills and adaptive behavior completed within the 24 months prior to initiation of demonstration services meets this requirement.
Standardized tests for language skills accepted by TRICARE are:
Reynell Developmental Language Scales
Test of Pragmatic Language – 2nd Edition (TOPL-2)
Preschool Language Scale -4th Edition (PLS-4)
Clinical Evaluation of Language Fundamentals -4th Edition (CELF-4)
Test of Language Development: Primary -3rd Edition (TOLF-P:3)
Standardized test accepted for adaptive behavior accepted by TRICARE is:
