TRICARE now covers 3D mammograms

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:
    1. History of breast cancer, Ductal Carcinoma In Situ (DCIS), Lobular Carcinoma In Situ (LCIS), Atypical Ductal Hyperplasia (ADH), or Atypical Lobular Hyperplasia (ALH);
    2. Extremely dense breasts when viewed by mammogram;
    3. Known BRCA1 or BRCA2 gene mutation;
    4. First-degree relative (parent, child, sibling) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves;
    5. Radiation therapy to the chest between the ages of 10 and 30 years; or
    6. 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.