Prophylactic Hysterectomy Now Covered by TRICARE

TRICARE Management Activity (TMA) recently instituted a contract change that adds Prophylactic Hysterectomy to TRICARE coverage. The implementation date is January 12, 2008, and is retroactive to January 1, 2006.

Prophylactic hysterectomy is the removal of the uterus before development of cancerous cells. Carefully selected indications have been developed for prophylactic hysterectomy and are included in this policy.

Prophylactic hysterectomy is covered:

• For women with a positive breast cancer genetic test (BRCA) who are about to undergo or are undergoing tamoxifen therapy
• For women who have been diagnosed with Hereditary Nonpolposis Colorectal Cancer (HNPCC) or are found to be carriers of HNPCC-associated mutations

If a qualified beneficiary received a prophylactic hysterectomy on or after January 1, 2006, and the claim was denied, the provider can contact TriWest and ask to have the claim reconsidered. For further information, refer to the TRICARE Policy Manual which can be found at www.tricare.mil.