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Mammogram

Routine Screening

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

Active duty services members require an approval from HNFS. TRICARE Prime (when seeing a network provider) and TRICARE Select beneficiaries do not require an approval from HNFS.

Screenings include a 2D mammogram or 3D mammogram (also known as a digital breast tomosynthesis).

*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 Screening

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.   

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