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TRICARE Expands Breast Cancer Screening Options  (Article 1)

Because the best way to contain breast cancer is to detect it early, TRICARE has expanded the screening options available for women at high risk of developing the disease.
 

A change in TRICARE policy has added coverage for magnetic resonance imaging (MRI) screening for breast cancer as a clinical preventive service for women in high-risk groups.|
 

“An MRI is a clearly superior tool for screening the highest risk women for breast cancer,” said Army Maj. Gen. Elder Granger, deputy director of the TRICARE Management Activity. “We want these women to have every chance to detect any cancer at the earliest possible stages.”
 
Breast cancer is the third most common cancer among TRICARE beneficiaries and the second most common cause of cancer death for women in the United States.
 
Asymptomatic TRICARE Prime beneficiaries age 30 or older, and asymptomatic TRICARE Standard beneficiaries age 35 or older, can now receive breast MRIs as an annual screening procedure if they are considered at high risk of developing breast cancer by American Cancer Society® guidelines. The guidelines include women with a:
  • BRCA1 or BRCA2 gene mutation
  • First-degree relative (parent, child or sibling) with a BRCA1 or BRCA2 gene mutation
  • Lifetime risk approximately 20 percent to 25 percent or greater as defined by BRCAPRO or other models
    that are largely dependent on family history
  • History of chest radiation between age 10 and age 30 History of Li-Fraumeni, Cowden or Bannayan-Riley-
    Ruvalcaba syndrome, or a first-degree relative with one of these syndromes

“The availability of MRI screenings does not reduce the importance of regular examinations,” Maj. Gen. Granger stressed. “All women over 39 years old need to get those annual mammograms. The key to dealing with cancer is
early detection.”
 
TRICARE coverage of breast MRIs is retroactive to March 1, 2007. Anyone who meets the criteria for a breast MRI is covered. If a qualified beneficiary received a breast MRI on or after March 1, 2007, and the claim was denied, the claim may be resubmitted for reimbursement.
 
TRICARE Prime enrollees may receive TRICARE-covered clinical preventive services from any network provider without a referral or prior authorization. If a service is not available from a network provider, an enrollee may receive that service from a non-network provider with a referral from their primary care manager and prior authorization from Humana Military.
 
For clinical preventive services, TRICARE Prime enrollees have no copayment, while TRICARE Standard beneficiaries are responsible for a deductible and cost-share.
 
For more information on TRICARE coverage for clinical preventive services, including MRIs for breast cancer screening, refer to the TRICARE Policy Manual, Chapter 7, Section 2.1 (for TRICARE Standard) and Section 2.2 (for TRICARE Prime).
 

  
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Created: December 17, 2007