3-D Screening Mammograms Covered Under Provisional Coverage Program
Tuesday, January 7, 2020
As of Jan. 1, 2020, TRICARE covers annual 3-D mammography screenings through its provisional coverage program. Previously, TRICARE only covered 3-D mammograms for diagnostic purposes. Because this is a provisional benefit, prior authorization is required regardless of TRICARE plan type.
As with 2-D screening mammograms, 3-D screening mammograms are covered for women who are:
- Age 40 or older, or
- Age 30 or older and at high risk (We offer a Letter of Attestation you can submit in lieu of clinical documentation for this category.)
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
TRICARE covers screening mammograms annually (every 12 months with a 30-day grace period). Active duty service members require an approval from HNFS for 2-D screening mammograms. All other beneficiaries do not require an approval for 2-D screening mammograms when seeing a network provider.
TRICARE continues to cover 3-D mammograms for diagnostic purposes.
For additional benefit details, please visit our Benefits A–Z page. Find information about TRICARE‘s provisional coverage program in the TRICARE Policy Manual, Chapter 13, Section 1.1.
