Does Medicare cover it?
Does Medicare cover mammograms?
Yes, under Part B: screening mammograms cost nothing with a provider who accepts assignment; diagnostic ones cost 20%. Switch the service in the estimator to compare the two.
What this service costs you
You pay
$0
| Medicare-approved amount | $123 |
| Medicare pays | $123 |
Preventive service: $0 if the provider accepts assignment. If something is found and treated during the visit, a cost can apply.
How this is calculatedMedicare Part B covers three kinds of mammograms, and they are not billed the same way. A baseline mammogram, usually the first one, is covered once in a lifetime for women aged 35 to 39. A screening mammogram is covered once every 12 months for women 40 and older, and it costs nothing when the provider accepts assignment: Medicare pays the full approved amount, $126 at national rates in 2026. A diagnostic mammogram, done to investigate a symptom, a sign of breast cancer or an abnormal screening result, is covered as often as medically necessary, but it follows the usual Part B rules: the $283 deductible, then 20% of the approved amount. At national rates a diagnostic mammogram of both breasts is approved at $157; it costs you $31 once the deductible is met and $157 if it is your first Part B bill of the year. A breast ultrasound is covered when it is medically necessary and ordered by your provider. Medicare Advantage plans must cover these mammograms too.
Screening or diagnostic mammogram
Diagnostic: you pay
$157
| Screening: you pay | $0 |
| Diagnostic, approved | $157 |
Costs computed by Radif Partners · Editorial policy · How the costs are calculated
Three mammograms, three rules
| Type | Who | How often | You pay |
|---|---|---|---|
| Baseline | Women 35 to 39 | Once in a lifetime | $0 with assignment |
| Screening | Women 40 and older | Once every 12 months | $0 with assignment |
| Diagnostic | When medically necessary | As often as needed | 20% after the deductible: $31 to $157 |
The difference between screening and diagnostic is not the machine but the reason. A screening mammogram checks a woman with no symptoms. A diagnostic mammogram investigates abnormalities, including symptoms or signs of breast cancer. The same visit can switch from one to the other if the radiologist decides more images are needed, and the bill switches with it.
What a diagnostic mammogram costs you
The approved amount comes from the physician fee schedule, with a part for the radiologist who reads the images and a technical part for the equipment and staff. It varies with your price area: $180 in Manhattan and $141 in Alabama, against $157 nationally. Your 20% follows it.
Screening or diagnostic mammogram
Diagnostic: you pay
$157
| Screening: you pay | $0 |
| Diagnostic, approved | $157 |
Three years, three bills
A year with only the yearly screening costs you nothing, while Medicare pays the provider $126. A year in which the screening in March leads to a call back for diagnostic images, with the deductible still open, costs you $157 for those images, because the whole approved amount falls into the deductible. The same call back in October, after other care has used up the deductible, costs you $31. With Medigap Plan G, the October bill drops to $0 and the March one stays at the deductible part. The order of your bills in the year matters as much as the test itself.
Follow-up after an abnormal result
After a screening that needs a second look, your doctor or other provider may order a diagnostic mammogram and a breast ultrasound to check specific areas. Medicare covers breast ultrasounds only when they are medically necessary and ordered by your provider. Each follow-up service is billed under Part B with the deductible and 20%; an MRI ordered later follows the same rules, with a higher amount in a hospital outpatient department than at an imaging center.
Medigap and Medicare Advantage
For the screening, Medigap changes nothing because there is nothing to pay. For diagnostic imaging, Plans A, B, C, D, F, G, M and N pay the whole 20%, Plan K half of it and Plan L three quarters. A Medicare Advantage plan must cover the same mammograms as Original Medicare and sets its own cost sharing for the diagnostic ones; its Summary of Benefits gives the copay.
Before the appointment
Check three things. That 12 months have passed since your last screening mammogram. That the facility and the radiologist accept assignment, so that the screening stays at $0. And, if you are called back, whether the next images will be billed as diagnostic. Coverage rules come from the medicare.gov mammograms page.