Cancer Screenings

• Colonoscopy—Individuals at average risk for colon cancer are covered once every 10 years beginning at age 50. For individuals at increased risk for colon cancer, these are the recommended age ranges and frequencies:
  • Hereditary non-polyposis colorectal cancer syndrome: Colonoscopy should be performed every two years beginning at age 25, or five years younger than the earliest age of diagnosis of colorectal cancer in an affected relative, whichever is earlier. Annual screening should be performed after age 40.
  • Familial risk of sporadic colorectal cancer: For first-degree relatives with sporadic colorectal cancer or adenomas before the age of 60, or multiple first-degree relatives with colorectal cancer or adenomas, colonoscopy should be performed every three to five years beginning 10 years earlier than the youngest affected relative.
    
    Note: Computed tomographic colonography (CTC) is covered as a colorectal cancer screening only when an optical colonoscopy is medically contraindicated or cannot be completed due to a known colonic lesion or structural abnormality, or when other technical difficulty is encountered that prevents adequate visualization of the entire colon. CTC is not covered as a colorectal cancer screening for any other indication or reason.
• Fecal Occult Blood Testing - Test annually starting at age 50.
• Mammograms-Perform annually for those over age 39. If your patient is at high risk for breast cancer, a baseline mammogram is appropriate at age 35, then annually thereafter. Asymptomatic TRICARE Prime beneficiaries age 30 or older, and asymptomatic TRICARE Standard beneficiaries age 35 or older, can receive a breast magnetic resonance imaging (MRI) scan annually as a 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
• Physical Examination for Colorectal Cancer-Digital rectal examination should be included in the periodic health examination of individuals 40 years of age and older.
• Proctosigmoidoscopy or Sigmoidoscopy-Perform once every three to five years beginning at age 50.
• Prostate Cancer-Conduct digital rectal examination and prostate-specific antigen screening annually for all men in the following categories:

• Routine Pap Smears-Conduct annually starting at age 18 (or younger if sexually active).  Frequency may be less often at your and the patient’s discretion, but not less than every three years.
• Skin Cancer-Exams may be sought at any age by individuals at high risk with a family history or increased sun exposure.

Cardiovascular

Clinical Preventive Exams

• TRICARE Standard—A comprehensive clinical preventive exam is covered if it includes or is rendered at the same time as a covered immunization, Pap smear, mammogram, colon cancer screening, or prostate cancer screening. Clinical preventive exam claims usually include a general medical examination diagnosis (V70 or V70.0). A separate diagnosis code for an immunization, screening Pap smear, screening mammogram, colon cancer screening, or prostate cancer screening is required for claims payment. See the individual screening services for frequency of coverage. School enrollment physicals for children ages 5–11 years are covered. Annual sports physicals are excluded.
• TRICARE Prime—In addition to the above, TRICARE Prime beneficiaries in each of the following age groups may receive one comprehensive clinical preventive exam without an accompanying immunization, Pap smear, mammogram, colon cancer screening, or prostate cancer screening (one exam per age group): 2–4, 5–11, 12–17, 18–39, and 40–64 years. While often rendered by a PCM, clinical preventive exams and accompanying immunization and screenings may be performed by any network provider without a referral. For screening Pap smears, mammograms, or colonoscopies, see the individual services for frequency of coverage.

Immunizations

• The vaccine has been recommended and adopted by the Advisory Committee on Immunization Practices (ACIP)
• The ACIP-adopted recommendations have been accepted by the Director of the CDC and the Secretary of Health and Human Services and published in a CDC Morbidity and Mortality Weekly Report (MMWR).

Infectious Disease Screening

Patient/Parent Education

• Accident and injury prevention
• Bereavement
• Cancer surveillance
• Dental health promotion
• Dietary assessment and nutrition
• Physical activity and exercise
• Safe sexual practices
• Stress
• Suicide-risk assessment
• Tobacco, alcohol, and substance abuse

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