December 19, 2019

DOD Announces TRICARE Coverage of Digital Breast Tomosynthesis

Assistant Secretary of Defense for Health Affairs Thomas McCaffery recently announced that TRICARE has approved provisional coverage of screening digital breast tomosynthesis (DBT).

Beginning January 1, 2020, TRICARE will cover annual DBT mammography screening for women age 40 or older, or who are age 30 or older, and have a 15% or more lifetime risk of breast cancer. The American College of Radiology® (ACR®) sent a letter to the Department of Defense (DOD) earlier this year urging DBT coverage in the TRICARE system.

TRICARE is the health care program for 9.5 million U.S. uniformed service members, retirees and their families. Under federal regulation, TRICARE follows the U.S. Preventive Services Task Force (USPSTF) recommendations for coverage of preventive and screening procedures.

Although USPSTF does not currently recommend DBT for breast cancer screening, the current coverage decision relies on an “emerging health care services and supplies” exception that allows for time-limited provisional coverage. Consistent with the requirements of this exception, the coverage is slated to expire on Dec. 31, 2025.

“This provisional coverage can be extended for up to five years, during which time we are hopeful that the USPSTF will recommend DBT for breast cancer screenings,” said McCaffery in a letter announcing the new policy to U.S. Sen. Martha McSally (R-AZ).

Legislation in both houses of Congress – H.R. 5238 and S. 2944 – would mandate DBT screening coverage as a primary and preventative health care service under the military health system and TRICARE program. Sponsors of these bills will continue to pursue the legislation’s enactment to ensure there is not a future lapse of DBT coverage for DOD beneficiaries.