Last updated: 06/04/2020
On January 1, 2020 TRICARE began covering Digital Breast Tomosynthesis (DBT), also known as three-dimensional (3D) mammography, for breast cancer screening in lieu of the conventional two-dimensional screening mammography. Prior authorization is not required for 3D mammography; however, benefit review is required for women 30-39 years old to ensure coverage criteria is met.
This benefit is not retroactive and any claims prior to January 1, 2020 will not be covered.
These mammograms are covered for:
- All women age 40 and older
- Women age 30 and older with who have a 15% or greater lifetime risk of breast cancer, or who have any of the following risk factors:
- History of breast cancer, Ductal Carcinoma In Situ (DCIS), Lobular Carcinoma In Situ (LCIS), Atypical Ductal Hyperplasia (ADH), or Atypical Lobular Hyperplasia (ALH);
- Extremely dense breasts when viewed by mammogram;
- Known BRCA1 or BRCA2 gene mutation;
- First-degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves;
- Radiation therapy to the chest between the ages of 10 and 30 years; or
- History of Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndrome, or a first-degree relative with a history of one of these syndromes.
Special processing code: DB
See Mammograms for more information as it becomes available.