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. 

Medicare

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 a once per calendar year basis. Once a woman reaches age 40, a screening mammogram has to have occurred at least 11 months after the last covered screening mammogram.

Medicaid

NC Medicaid covers 2D and 3D screening mammography for female beneficiaries as a preventive health measure for the purpose of early detection of breast cancer. Information about Medicaid coverage is available at the North Carolina Department of Health and Human Services

• Women 20-39 years. Medicaid will pay for one exam annually when the recipient has (this is not an all-inclusive list):
  • 1. Documented positive BRCA mutation
    2. Personal history of ovarian cancer
    3. Personal history of chest radiation
    4. Personal history of atypical/high risk biopsy(ies)
    5. Strong family history of breast cancer (first-degree relative: mother, sister, daughter)
• Women 35-39 years. Medicaid will pay for one baseline exam within the five years.
• Women 40 years and older. Medicaid will pay for one exam annually.