Does Medicare cover mammograms?
Usually covered
Yes — Medicare Part B covers a screening mammogram every 12 months at no cost for women 40 and older (plus one baseline mammogram between 35 and 39), but the moment a mammogram becomes diagnostic, normal Part B cost-sharing kicks in.
- Covered when You are a woman 40 or older getting a screening mammogram and your last covered screening was at least 12 months ago — Part B pays 100% when the provider accepts assignment, with no deductible.
- Covered when You are a woman between 35 and 39 and have never had a mammogram — Medicare covers one baseline mammogram in your lifetime in that window, also at no cost with assignment.
- Not when You try to get a second screening mammogram inside the 12-month window with no symptoms and no medical indication — Medicare will not pay for extra routine screenings.
What flips the answer
- Covered when
You are a woman 40 or older getting a screening mammogram and your last covered screening was at least 12 months ago — Part B pays 100% when the provider accepts assignment, with no deductible.
- Covered when
You are a woman between 35 and 39 and have never had a mammogram — Medicare covers one baseline mammogram in your lifetime in that window, also at no cost with assignment.
- Covered when
The mammogram is diagnostic — ordered because of a lump, symptoms, or an abnormal screening result — Medicare covers it whenever medically necessary and as often as needed, though with deductible and 20% coinsurance rather than $0.
- Not covered when
You try to get a second screening mammogram inside the 12-month window with no symptoms and no medical indication — Medicare will not pay for extra routine screenings.
- Not covered when
The provider does not accept Medicare assignment — the zero-cost guarantee for screening only holds at assignment-accepting providers, and non-participating providers can charge you more.
- Not covered when
You are in a Medicare Advantage plan and use an out-of-network imaging center — the plan may pay less or nothing, depending on plan type, even for a service Original Medicare would cover in full.
Key facts
- Verdict
- Usually covered
- Applies to
- mammograms · Medicare
- Covered when
- You are a woman 40 or older getting a screening mammogram and your last covered screening was at least 12 months ago — Part B pays 100% when the provider accepts assignment, with no deductible.
- Not covered when
- You try to get a second screening mammogram inside the 12-month window with no symptoms and no medical indication — Medicare will not pay for extra routine screenings.
- Verified
- 2026-08-12 · 3 primary sources
Mammograms are one of Medicare's cleanest preventive benefits, and the structure is worth knowing precisely because the cost answer changes with the label on the order. Medicare Part B covers three kinds of mammograms: a baseline mammogram (one in your lifetime, for women 35–39), screening mammograms (once every 12 months for women 40 and older), and diagnostic mammograms (whenever they are medically necessary, with no annual limit). The screening and baseline versions are preventive services — you pay nothing for the test itself as long as the provider accepts assignment, and the Part B deductible does not apply.
The distinction that surprises people is screening versus diagnostic. A screening mammogram is the routine annual check when nothing is wrong. A diagnostic mammogram investigates something specific — a lump, a symptom, or an abnormality flagged on the screening image. Diagnostic mammograms are covered too, and can be done more often than once a year, but they are billed as regular Part B services: after you meet the annual Part B deductible, you pay 20% of the Medicare-approved amount. So the same machine and the same half hour can cost $0 or a real bill depending on why the study was ordered — and if a screening finds something and you are called back, the follow-up imaging is diagnostic. Medicare also covers a follow-up breast ultrasound when your provider orders it as medically necessary.
In Medicare Advantage the entitlement is the same but the plumbing differs. Medicare Advantage plans must cover everything Original Medicare covers, including zero-dollar screening mammograms, and preventive services are generally free in-network. The differences show up at the edges: you will usually need to use an imaging facility in the plan's network, and the cost-sharing for diagnostic mammograms follows the plan's own copay schedule rather than the 20% coinsurance. Check your plan documents or call the plan before a diagnostic study if cost matters.
One practical note on scheduling: the every-12-months clock for screening is measured from your last screening mammogram, and booking a few weeks early can cause a claim denial in some billing systems. If your imaging center offers to schedule you at eleven months, ask them to verify the date Medicare has on file. For plan questions or a denied claim, medicare.gov, 1-800-MEDICARE, and your local State Health Insurance Assistance Program (SHIP) are the neutral places to get help.
What people typically pay
Screening and baseline mammograms cost $0 at providers who accept assignment (the Part B deductible does not apply). Diagnostic mammograms cost 20% of the Medicare-approved amount after the Part B deductible; Medicare Advantage plans substitute their own copays.
Cash prices for a screening mammogram commonly run roughly $100–$300, and diagnostic mammograms — often paired with ultrasound — frequently land in the $150–$500+ range depending on facility and region.
The bigger cost variable is not the price of the test but the label on the order: the same visit can be $0 preventive or deductible-plus-coinsurance diagnostic.
How to actually get it covered
Confirm which type of mammogram is being ordered — screening (routine, no symptoms) or diagnostic (investigating something) — because that single word determines whether you pay $0 or deductible-plus-20%.
Verify the timing for screening: at least 12 months since your last covered screening mammogram. If you are unsure of the date Medicare has on file, check your claims history at medicare.gov or call 1-800-MEDICARE.
Pick a facility that accepts Medicare assignment (or, in a Medicare Advantage plan, one in your plan's network) — ask directly when you book, since this is what protects the zero-dollar preventive pricing.
Bring your Medicare (or plan) card and mention it is your annual screening so the claim is coded as preventive; miscoded screenings are one of the most common — and most fixable — reasons a free mammogram generates a bill.
If you are called back for follow-up imaging, expect it to be billed as diagnostic — ask the facility for an estimate of your share, and remember the follow-up is still covered, just with normal cost-sharing.
If a screening mammogram generates a bill you did not expect, ask the facility to review the billing code before paying, and use 1-800-MEDICARE or your SHIP for free help disputing it.
Common questions
How often will Medicare pay for a mammogram?
For screening, once every 12 months for women 40 and older, plus one baseline mammogram between ages 35 and 39. There is no such clock for diagnostic mammograms — Medicare covers those whenever they are medically necessary, even multiple times in a year, because they are investigating a specific finding rather than routinely screening. The 12-month screening interval is measured from your last screening, so scheduling a few weeks early can trigger a denial.
Why did I get a bill for my mammogram if Medicare covers it 100%?
Usually one of three reasons: the study was ordered or coded as diagnostic rather than screening, the provider did not accept Medicare assignment, or you had the screening less than 12 months after your last one. Diagnostic mammograms carry the Part B deductible and 20% coinsurance even though they are covered. If you believe your routine screening was miscoded, ask the imaging facility's billing office to review the claim — recoding a genuine screening is a routine fix.
Does Medicare cover 3D mammograms (tomosynthesis)?
Medicare covers mammography including newer digital technologies when your provider uses them, and screening remains a covered preventive service either way. What matters for your wallet is still the screening-versus-diagnostic label, the 12-month interval, and whether the facility accepts assignment — not the specific imaging technology. If a facility tells you an upgrade fee applies, ask whether the charge is for a Medicare-covered service before agreeing to pay out of pocket.
Are mammograms free in Medicare Advantage plans too?
Yes — Medicare Advantage plans must cover everything Original Medicare covers, and in-network screening mammograms are generally $0. The differences are network rules and diagnostic cost-sharing: you typically must use the plan's contracted imaging facilities, and a diagnostic mammogram follows the plan's copay schedule instead of Part B's 20% coinsurance. Check the plan's Evidence of Coverage, or call the plan, before scheduling if you have had abnormal results before.
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