TRICARE now covers 3-D mammography

February 12, 2020
Area(s) of Interest: Payor Issues and Reimbursement 

As of January 1, 2020, TRICARE now covers annual 3-D mammography screenings through its provisional coverage program. Previously, TRICARE only covered 3-D mammograms for diagnostic purposes.  As a provisional benefit, prior authorization for 3-D mammography 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 (a Letter of Attestation can be submitted in lieu of clinical documentation for this category)

High-risk indicators include:

  • A lifetime risk of breast cancer of 15% 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

For additional benefit details, please visit the TRICARE West website under the Benefits A–Z page.


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