Does Medicare Pay for 3D Mammograms?

As medical technology advances, 3D mammography, also known as breast tomosynthesis, offers enhanced imaging capabilities for breast cancer detection. Many individuals question how Medicare covers these advanced screening methods. This article clarifies the extent to which Medicare covers 3D mammograms, providing important details for those seeking this diagnostic tool.

Understanding 3D Mammograms and Medicare

A 3D mammogram, also known as breast tomosynthesis, creates a comprehensive, three-dimensional view of breast tissue by taking multiple images from various angles. This differs from a traditional 2D mammogram, which produces only two-dimensional images. The multi-layered view offered by 3D technology can improve the detection of abnormalities, especially in dense breast tissue, and may reduce the need for follow-up imaging.

Medicare is the federal health insurance program for individuals aged 65 or older, as well as some younger people with disabilities or specific medical conditions. Medicare Part B specifically addresses outpatient care, including preventive services like mammograms.

Medicare Coverage for 3D Mammograms

Medicare Part B provides coverage for screening mammograms, including 3D mammograms, when deemed medically appropriate. For women aged 40 and older, Medicare covers one screening mammogram every 12 months. A baseline mammogram is also covered once in a lifetime for women aged 35 to 39. These screening services are designed for individuals who do not have symptoms of breast cancer.

Medicare’s coverage rules vary between screening and diagnostic mammograms. A screening mammogram is a preventive measure performed when no symptoms are present. In contrast, a diagnostic mammogram is ordered when a healthcare provider needs to investigate a specific concern, such as a new lump, pain, or an abnormal finding from a screening mammogram. Medicare Part B also covers diagnostic mammograms if they are medically necessary, and there is no age limit for this coverage. A doctor’s order is required for both screening and diagnostic mammograms.

Costs and Other Considerations

For screening mammograms, including 3D tomosynthesis, Medicare Part B generally covers 100% of the Medicare-approved amount. Beneficiaries typically pay nothing out-of-pocket for these preventive services, provided the healthcare provider accepts Medicare assignment. This zero-cost sharing applies to the annual screening mammogram.

However, if a diagnostic mammogram is needed, different cost-sharing rules apply. For diagnostic mammograms, after meeting the annual Medicare Part B deductible, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount. For instance, in 2025, the Part B deductible is $257. The 20% coinsurance then applies to the diagnostic mammogram cost.

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are required to cover at least all the benefits that Original Medicare (Parts A and B) covers, including 3D mammograms. While providing the same level of coverage, Medicare Advantage plans may have different cost-sharing structures, such as varying copayments or coinsurance amounts, and often operate within specific provider networks.

For individuals enrolled in Original Medicare, Medigap policies (Medicare Supplement Insurance) can help cover some out-of-pocket costs, such as the 20% coinsurance for diagnostic mammograms. Medigap plans do not directly cover the mammogram service itself but can reduce the financial burden of costs not paid by Original Medicare. If a 3D mammogram is performed for reasons not considered medically necessary or by a provider who does not accept Medicare assignment, out-of-pocket expenses could be higher.