Medicare & Medicaid Coverage for Screening Mammography
The Centers for Medicare & Medicaid Services (CMS) pays for a variety of preventive services and screenings, including screening mammography. CMS does not pay for 3D mammograms.
Medicare covers 2D and 3D (Tomosynthesis) screening mammography for female recipients as a preventive health measure for the purpose of early detection of breast cancer. Medicare does not require a physician’s prescription or referral for screening mammography. Information about Medicare coverage is available online at medicare.gov or through the Medicare Hotline at 1-800-MEDICARE (1-800-633-4227).
Medicare will pay for a screening 3D (Tomosynthesis) Mammogram with no out of pocket expense for patients.
Medicare does not pay for screening mammograms for female beneficiaries younger than 35.
Medicare will pay for one baseline mammogram for female beneficiaries between the ages of 35 and 39.
Medicare covers screening mammography for women age 40 and over on an annual basis. Once a woman reaches age 40, a screening mammogram has to have occurred at least 11 months after the last covered screening mammogram.