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Does Medicare cover mammograms?

Yes. Medicare Part B covers three kinds: a baseline mammogram, a yearly screening mammogram, and diagnostic mammograms. Screening is free when the provider accepts assignment. Diagnostic is not, and the word on the order decides which one you get billed for.

This page is about mammograms. For how often Medicare pays for blood work and other lab tests, see our free chart of Medicare's screening schedules.

What a mammogram is, and the three kinds

Medicare.gov: "Mammograms are x-ray pictures of the breast that check for breast cancer." It describes the three kinds this way: "A baseline mammogram (usually your first mammogram) creates a record of your breast tissue that's compared to all future mammograms. A screening mammogram monitors your breast health every year. Diagnostic mammograms investigate abnormalities, including symptoms or signs of breast cancer."

Medicare.gov: "Part B covers baseline, screening, and diagnostic mammograms."

Who qualifies and how often

• Baseline. "If you're a woman between 35–39." How often: "Once in your lifetime."
• Screening. "If you're a woman 40 or older." How often: "Once every 12 months."
• Diagnostic. "If it's medically necessary." How often: "More frequently than once a year, if medically necessary."

Medicare's provider chart says the same thing in a table: "Aged 35–39: 1 baseline / Aged 40 and older: Annually."

What you pay

Medicare.gov gives the two prices side by side. "Baseline and screening mammograms: You pay nothing for the test if provider accepts assignment." "Diagnostic mammograms: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount."

The Claims Processing Manual explains where the free screening comes from: "Section 4101 of the Balanced Budget Act (BBA) of 1997 provides for annual screening mammographies for women over age 39 and waives the Part B deductible." And: "There is no Part B deductible or coinsurance for screening mammographies."

"Once every 12 months" means 11 full months

The Claims Processing Manual's age table reads: "Over age 39 Annual (11 full months have elapsed following the month of last screening." For the baseline it says: "35-39 Baseline (pay for only one screening mammography performed on a woman between her 35th and 40th birthday)." And: "Under age 35 No payment allowed for screening mammography."

So the count starts from the month of the last screening, not the day, and eleven full months must pass after that month before the next screening is payable.

3D mammograms

Medicare's provider chart lists the 3D screening code alongside the standard one: 77067, "Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed," and 77063, "Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)." Its note: "Use 77063 as an add-on code to 77067 (2D mammography) when you use tomosynthesis (3D mammography)." The chart's "Patient Pays" line for the screening entry is "No copayment, coinsurance, or deductible."

In one line, the codes: 77067 is a screening mammogram, 77063 is the 3D add-on to it, 77065 and 77066 are diagnostic mammograms (one breast and both breasts), and G0279 is a diagnostic 3D mammogram.

When a screening turns into a diagnostic on the same day

Sometimes the radiologist sees something on the screening images and takes more pictures the same day. Medicare has a rule for that. The provider chart: "If you perform and bill a screening mammogram and a diagnostic mammogram on the same day, use modifier GG to show a screening mammography turned into a diagnostic mammography." The Claims Processing Manual says what happens to the claim: Medicare's contractors "will pay both the screening and diagnostic mammography tests."

Medicare pays both claims: the screening under the screening rules above, and the diagnostic under the diagnostic rules, which carry the Part B deductible and the 20 percent.

What counts as a diagnostic mammogram

The Claims Processing Manual lists three situations for a diagnostic mammogram: "A patient has distinct signs and symptoms for which a mammogram is indicated; A patient has a history of breast cancer; or A patient is asymptomatic, but based on the patient's history and other factors the physician considers significant, the physician's judgment is that a mammogram is appropriate."

The third one is worth reading twice. A person with no symptoms can still be ordered a diagnostic mammogram, on the doctor's judgment, and it is billed as a diagnostic.

Breast ultrasound

Medicare.gov: "Medicare only covers medically necessary breast ultrasounds when your health care provider orders them." There is no screening ultrasound benefit on the page.

Every year, or every two years?

Medicare pays for a screening mammogram every year. The U.S. Preventive Services Task Force, in its April 30, 2024 recommendation, says: "The USPSTF recommends biennial screening mammography for women aged 40 to 74 years." Biennial means every two years.

These are two different things. The task force says how often it thinks women should be screened. Medicare says how often it will pay. A woman who screens every year is within Medicare's rule. A woman who screens every two years is also within it. Which is right for you is a question for your doctor, not for this page.

If you have Medicare Advantage

Medicare's preventive services guide says: "If you have a Medicare Advantage Plan, another Medicare health plan, or both Medicare and Medicaid, your coverage, costs, and rules might be different. Check with your plan or state Medicaid office for more details about the preventive services they offer." For what can and cannot change under a plan, see Medicare Advantage and lab tests.

Before you go

This is ClaraCover's checklist, built from the rules above. Three questions for the office that books the appointment.

1. "Is this being ordered as a screening or a diagnostic?" Screening is free with assignment. Diagnostic is 20 percent after the Part B deductible.
2. "What was the date of my last screening mammogram?" Eleven full months must have passed since that month.
3. "If it is diagnostic, what would I owe?" Ask whether the provider accepts assignment and whether you have met the Part B deductible this year.

Sources

• Medicare.gov: Mammograms
• Medicare.gov: Your Guide to Medicare Preventive Services (booklet 10110, May 2026)
• CMS: Medicare Preventive Services educational tool (MLN006559), Mammography Screening entry
• CMS: Medicare Claims Processing Manual, chapter 18, section 20, Mammography
• U.S. Preventive Services Task Force: Breast Cancer, Screening (final recommendation dated April 30, 2024)

Checked September 27, 2026. This page explains published Medicare rules. It is not medical or insurance advice, does not say who should have a mammogram or how often, and cannot tell you whether your own test will be covered; your doctor's office and Medicare can. ClaraCover has no relationship with any provider or plan.