Medicare Coverage: Screening vs Diagnostic Mammograms

If you are on Medicare, you may wonder what your mammogram will cost — and whether screening and diagnostic exams are covered differently. The answer is yes, and the differences matter for your wallet.

Screening vs Diagnostic: What Is the Difference?

A screening mammogram is a routine exam for women with no symptoms. It checks for breast cancer before any problems appear.

A diagnostic mammogram is ordered when something has already been found — a lump, pain, nipple discharge, or an abnormal screening result. Diagnostic exams often include additional images and take longer.

How Medicare Covers Screening Mammograms

Medicare Part B covers one screening mammogram every 12 months for all women age 40 and older. Under current rules:

• You pay $0 for the mammogram (no deductible, no copay)
• The facility must accept Medicare assignment
• Both 2D and 3D mammography are covered
• No doctor referral is required

This is one of Medicare's preventive services, so it is covered at 100% when performed at a participating facility like AMI.

According to Medicare.gov, the screening benefit has no out-of-pocket cost as long as you meet the age and frequency requirements.

How Medicare Covers Diagnostic Mammograms

Diagnostic mammograms are covered by Medicare Part B, but the cost-sharing rules are different:

• The Part B deductible applies (currently $257 per year in 2026)
• After the deductible, you typically pay 20% coinsurance
• A doctor order or referral is required
• Additional views and ultrasound may also be covered

Important: If your screening mammogram finds something suspicious and you are called back for a diagnostic mammogram, the follow-up exam is classified as diagnostic — meaning cost-sharing applies.

The American Cancer Society recommends that women discuss any unexpected costs with their imaging facility before the exam.

What About Medicare Advantage Plans?

Medicare Advantage (Part C) plans must cover at least the same benefits as Original Medicare. However, they may have different:

• Copay amounts
• Network restrictions
• Prior authorization requirements

Check with your specific plan. AMI accepts most Medicare plans — our team can verify your coverage before your appointment.

The 11-Month Rule

A common source of confusion: Medicare covers a screening mammogram every 12 months, counted from the date of your last screening. If you had a screening on January 15, your next covered screening is January 15 of the following year.

If you accidentally schedule too early, you may be responsible for the full cost.

3D Mammography and Medicare

Medicare covers 3D mammography (tomosynthesis) at no extra cost for screening exams. This is great news, because 3D mammography detects more cancers and reduces false-positive callbacks compared to 2D alone, according to the Radiological Society of North America.

Tips for Medicare Patients

• Schedule your annual screening — It is free, so take advantage of it
• Know the date of your last mammogram — Avoid scheduling too early
• Ask about diagnostic costs upfront — If you are called back, understand your cost share
• Choose a participating facility — This ensures Medicare rates apply
• Bring your Medicare card — We need it to bill correctly

Schedule Your Mammogram at AMI

Advanced Medical Imaging in Seminole, FL, offers state-of-the-art Hologic 3D mammography with results typically available within 24 to 48 hours. Call (727) 398-5999 or schedule online.

Sources: - Medicare.gov — Mammogram Coverage - ACS — Mammogram Basics - RSNA — Digital Breast Tomosynthesis