Update to 3-D Screening Mammogram Services
Monday, June 7, 2021
On Jan. 1, 2020, TRICARE expanded coverage for breast cancer screenings to include digital breast tomosynthesis, or 3-D mammography, as a preventive benefit through the provisional coverage program. Health Net Federal Services, LLC has recently received clarification from the Defense Health Agency regarding copayments/cost-shares and approval requirements.
Here’s what you need to know:
- 3-D screening or routine mammograms are covered as a preventive service.
- TRICARE Select enrollees pay $0 for breast cancer screening at either a network or non-network provider.
- TRICARE Prime enrollees do not need a referral or authorization for breast cancer screenings, and have a $0 copayment when receiving services from any network provider. (Exception: Active duty service members require a referral.)
- TRICARE Prime enrollees who are getting a breast cancer screening from a non-network provider may have to pay point-of-service fees unless they have a primary care manager referral on file.
Based on this clarification, we are adjusting claims paid from Jan. 1, 2020 to present. No action is needed on your part.
As a reminder, 3-D screening mammograms (as well as 2-D mammograms) are covered for women who are:
- Age 40 or older, or
- Age 30 or older and at high risk
TRICARE covers screening mammograms annually (every 12 months with a 30-day grace period). For more information on this benefit, including what constitutes high risk, please visit our Mammogram Details page. Find information about TRICARE‘s provisional coverage program in the TRICARE Policy Manual, Chapter 13, Section 1.1.
