Authorization Updates for 3-D Mammograms and Platelet Rich Plasma Injections
Thursday, April 23, 2020
Within the last several months, TRICARE announced updates to its provisional coverage program for 3-D mammogram screening and platelet rich plasma injections. Both of these limited benefits initially required prior authorization. TRICARE has since relaxed the prior authorization requirement for non-active duty beneficiaries. Below is an overview of these two benefits:
As of Jan. 1, 2020, TRICARE covers annual 3-D mammography screenings through its provisional coverage program. Previously, TRICARE only covered 3-D mammograms for diagnostic purposes.
As with 2-D screening mammograms, 3-D screening mammograms are covered for women who are:
- Age 40 or older, or
- Age 30 or older and at high risk
TRICARE covers screening mammograms annually (every 12 months with a 30-day grace period). Active duty service members (ADSMs) require an approval from HNFS for 2-D and 3-D screening mammograms. All other TRICARE Prime beneficiaries who see network providers and TRICARE Select beneficiaries do not require an approval from HNFS. Prime beneficiaries who see non-network providers without an approval are subject to Point of Service fees.
TRICARE continues to cover 3-D mammograms for diagnostic purposes. For additional benefit details, please visit our mammogram benefit details page.
Platelet Rich Plasma (PRP) Injections
In 2019, TRICARE announced the addition of PRP injections to its provisional coverage program. This benefit is for beneficiaries who have been diagnosed with mild to moderate chronic osteoarthritis of the knee or lateral epicondylitis, where conservative treatment such as physical therapy, diet and exercise was unsuccessful after three months or contraindicated. Retroactive to Oct. 1, 2019, except for ADSMs, TRICARE Prime beneficiaries who see network providers and TRICARE Select beneficiaries do not require an approval from HNFS. Prime beneficiaries who see non-network providers without an approval are subject to Point of Service fees. You can continue to use the PRP Letter of Attestation for active duty authorization requests.
Learn more about TRICARE’s Provisional Coverage Program in the TRICARE Policy Manual, Chapter 13, Section 1.1.