Does Medicare Part B Cover Mammograms?
Navigate Medicare Part B coverage for mammograms. Get clear insights into how these vital health screenings are supported and your financial responsibilities.
Medicare Part B provides coverage for mammograms, which are an important tool in the early detection and diagnosis of breast conditions. This coverage is categorized based on the purpose of the mammogram: either as a preventive screening measure or as a diagnostic tool for specific concerns. Understanding the distinctions between these types of mammograms and their respective coverage rules under Medicare Part B is important for beneficiaries.
Screening Mammogram Coverage
A screening mammogram is a preventive service performed regularly to check for early signs of breast cancer in individuals who do not have any symptoms or specific breast concerns. Medicare Part B covers these routine examinations as part of its preventive care benefits. This includes one baseline mammogram for individuals between the ages of 35 and 39.
For individuals aged 40 and older, Medicare Part B covers one screening mammogram every 12 months. When a healthcare provider accepts Medicare assignment, beneficiaries typically pay nothing out-of-pocket for these screening services.
Diagnostic Mammogram Coverage
In contrast to screening mammograms, a diagnostic mammogram is performed when an individual has specific symptoms, an abnormal finding from a physical exam, or requires a follow-up to an abnormal screening mammogram. This type of mammogram is conducted to investigate a potential medical condition, such as a lump or other concerning change in breast tissue. Diagnostic mammograms are considered medically necessary services rather than preventive ones.
Medicare Part B covers diagnostic mammograms, but the cost-sharing rules differ from those of screening mammograms. For these services, the standard Medicare Part B deductible applies. After the deductible has been met, beneficiaries are typically responsible for 20% of the Medicare-approved amount for the service.
Costs and Frequency of Coverage
The financial obligations for mammograms under Medicare Part B vary significantly depending on the type of service. Screening mammograms are generally covered at 100% of the Medicare-approved amount, provided the healthcare provider accepts assignment. This includes one baseline mammogram for those aged 35 to 39 and an annual screening mammogram for individuals 40 and older.
For diagnostic mammograms, beneficiaries are subject to the Medicare Part B annual deductible, which is $257 in 2025. After meeting this deductible, beneficiaries pay a 20% coinsurance of the Medicare-approved amount for the diagnostic procedure. There is no specific limit on the frequency of diagnostic mammograms; Medicare Part B covers as many as are medically necessary to diagnose or monitor a condition.