TRICARE Expands Breast Cancer Screening Options to Include 3-D Mammography

TRICARE is committed to improving preventive health care services for women. On Jan. 1, 2020, TRICARE expands coverage for breast cancer screenings to include digital breast tomosynthesis, or 3-D mammography. TRICARE will cover 3-D mammography as a preventive health care service through the provisional coverage program.

According to the American Cancer Society, breast cancer is the most diagnosed cancer in women after skin cancers. About 1 in 10 women in the U.S. develop breast cancer in their lifetime.

“Women’s health is a priority at the Defense Health Agency,” said Elan Green, chief of the Medical Benefits and Reimbursement Section for the TRICARE Health Plan at the Defense Health Agency. “Currently, the U.S. Preventive Services Task Force hasn’t found sufficient information to develop a recommendation for or against this service. However, recognizing that 3-D mammography is rapidly becoming the standard of care, the DHA approved provisional coverage of 3-D mammograms for breast cancer screening.”

Previously, TRICARE only covered 3-D mammograms for diagnostic purposes. This means a physician could order them for at-risk patients or for further diagnosis. For breast cancer screenings, TRICARE covered 2-D mammograms.

What’s 3-D mammography?

3-D mammography uses an X-ray machine to create a 3-D image of the breast. This results in greater accuracy when detecting abnormalities. It also decreases false positives. So, there’s less chance of having to return for a second screening and potentially unnecessary breast biopsies.

Who now can get 3-D mammography?

Beginning Jan. 1, you may be eligible for annual 3-D mammography screenings if you’re a woman who is:

  • Age 40 or older.
  • Age 30 or older and at high risk. This means you have a 15% or more lifetime risk of breast cancer.

If you or your doctor prefer 2-D mammograms, TRICARE will continue to cover them. But you must meet the above criteria.

3-D mammography falls under the provisional coverage program. This means you need pre-authorization. Your provider must first get pre-authorization from your regional contractor.

What’s the provisional coverage program?

The provisional coverage program covers certain emerging health care services and supplies. These services or supplies are under clinical trials and ongoing evaluation. TRICARE can extend coverage for up to five years. TRICARE will then determine if the service or supply will become a covered benefit.

Take command of your health.

Women with breast cancer often don’t have symptoms. This is one reason why preventive breast cancer screenings are critical. Take command of your health; learn about 3-D mammography and your TRICARE benefit.

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Last Updated 5/13/2020