Medicare Part B covers Mammogram at 80% after the Part B deductible. Here's the full cost-sharing breakdown, admission status rules, and Medicare Advantage differences.
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Does Medicare Cover Mammograms? (2026)
Yes. Medicare Part B covers screening mammograms at no cost (no deductible, no coinsurance) for women age 40 and older, once every 12 months. Diagnostic mammograms are covered at 80% after the Part B deductible — you pay 20%.
Quick answer:
- Screening mammogram (age 40+, annually): $0 — no deductible, no coinsurance
- Diagnostic mammogram: 80% covered after $257 Part B deductible — you pay 20%
- Prior authorization: Not required under Original Medicare
Screening Mammogram Under Medicare
Medicare Part B covers one screening mammogram every 12 months for women age 40 and older. This coverage is:
A screening mammogram is $0 — until a callback or a symptom re-codes it as diagnostic and the bills start.
Your personalized cost report includes:
- ✓ When a "free" screening becomes a cost-shared diagnostic mammogram — and how to see it coming
- ✓ The separate radiologist bill most patients miss (and how to verify it's in-network)
- ✓ Why a hospital outpatient department can cost far more than a breast center for the identical study
- ✓ When 3D tomosynthesis adds a separate charge — and the questions to ask before you schedule
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
- $0 out-of-pocket — the Part B deductible does NOT apply to screening mammograms
- Annual (not biennial — more frequent than some commercial ACA plans)
- At a Medicare-enrolled facility and read by a Medicare-enrolled radiologist
- CPT code 77067 (digital) or 77063 (tomosynthesis add-on)
Note on 3D mammography (tomosynthesis): Medicare covers 3D digital breast tomosynthesis as part of the screening mammogram. It should be covered at $0 when billed alongside the screening code.
Diagnostic Mammogram Under Medicare
A diagnostic mammogram — ordered to evaluate a symptom, abnormal finding, or after a prior screening flagged an area of concern — is covered at the standard Part B cost-sharing:
- Medicare pays 80% of the allowed amount
- You pay 20% coinsurance AFTER the $257 annual Part B deductible
- Medigap (supplemental policies) generally pay the 20% coinsurance
Medicare Advantage (Part C)
Medicare Advantage plans cover screening mammograms at $0 (required by CMS) and diagnostic mammograms at plan cost-sharing. Some MA plans apply a copay for diagnostic mammograms. Check your plan's Summary of Benefits.
Related Cost Information
Related: Is a mammogram covered by insurance? → · Mammogram billing surprises →
A screening mammogram is $0 — until a callback or a symptom re-codes it as diagnostic and the bills start.
Your personalized cost report includes:
- ✓ When a "free" screening becomes a cost-shared diagnostic mammogram — and how to see it coming
- ✓ The separate radiologist bill most patients miss (and how to verify it's in-network)
- ✓ Why a hospital outpatient department can cost far more than a breast center for the identical study
- ✓ When 3D tomosynthesis adds a separate charge — and the questions to ask before you schedule
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
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About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
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