One screening mammogram every 12 months* is covered for women with average risk beginning at age 40. Women with a high risk of breast cancer may receive a screening mammogram beginning at age 30. High-risk indicators include:
- a lifetime risk of breast cancer of 15 percent or greater using standard risk assessment models such as: Gail model, Claus model or Tyrer-Cuzick
- history of breast cancer
- known BRCA1 and BRCA2 gene mutation
- a parent, child or sibling with a BRCA1 or BRCA2 gene mutation and the beneficiary has not had genetic testing for this mutation
- radiation therapy to the chest between 10 and 30 years of age
- history of LiFraumeni, Cowden or Bannayan-Riley-Ruvalcaba syndrome, or a parent, child or sibling with a history of one of these syndromes
Types of Screenings Covered
- 2D mammograms are covered as a preventive service. Active duty service members require an approval from HNFS for 2D screening mammograms. All other beneficiaries do not require an approval when seeing a network provider.
- 3D mammograms, also known as digital breast tomosynthesis, are covered under TRICARE's provisional coverage program. An approval from HNFS is required for all beneficiaries (excluding those with other health insurance).
*A grace period allows a mammogram 30 days prior to the anniversary date of the last exam.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Diagnostic (non-routine) mammography, including 3D renderings, to further define breast abnormalities or other problems is a covered benefit. View our Approval Requirements for Ancillary Services page to determine if the type of diagnostic screening requires an approval from HNFS.