Breast MRI

Coverage

TRICARE covers an annual breast MRI screening beginning at age 30, for women who have a 20% or greater lifetime risk of breast cancer. Your risk is determined by risk assessment tools based on family history, or if you have any of the following risk factors:

• A known BRCA1 or BRCA2 gene mutation
• A first-degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and haven't had genetic testing themselves
• Radiation therapy to the chest between the ages of 10 and 30 years
• A history of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first-degree relative with a history of one of these syndromes

TRICARE covers genetic counseling provided by a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS before BRCA1 or BRCA2 gene testing:

• For women identified as high risk for breast cancer by their primary care manager
• For men if it’s medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and appropriate
• If you have a history of radiation therapy to the chest between the ages of 10 and 30
• If you have a history of LiFraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a parent, child, or sibling with a history of one of these syndromes

Referrals

• Do you have TRICARE Prime, the US Family Health Plan, or TRICARE Young Adult-Prime? You don’t need a referral for a breast MRI if you use a TRICARE network provider. Otherwise, you do need a referral. 
• For all other TRICARE plans, you don’t need a referral.
• Note: If you have TRICARE For Life coverage and live in the U.S. or a U.S. territory, you must also follow Medicare’s rules.