Short answer: Medicare Part B covers eligible screening mammograms and medically necessary diagnostic mammograms. Three-dimensional mammography, also called digital breast tomosynthesis, has specific Medicare billing codes and may be covered when it is furnished and billed with the related mammogram.
Original Medicare coverage
Part B covers one baseline mammogram for women ages 35 through 39. It covers one screening mammogram every 12 months for women age 40 or older. Diagnostic mammograms are covered when medically necessary. Medicare describes a diagnostic mammogram as one used to investigate an abnormality, symptom, or possible sign of breast cancer.
CMS identifies separate billing codes for screening and diagnostic digital breast tomosynthesis. A provider must submit the 3D service with the appropriate primary mammography service. Coverage still depends on the underlying screening or diagnostic mammogram meeting Medicare requirements.
Eligibility and limits
Screening frequency and age rules apply to screening mammograms. Diagnostic mammograms may be provided more often when medically necessary. A treating provider may also order a breast ultrasound or another test after a mammogram. Those additional tests have their own coverage rules.
Costs
You pay nothing for a covered baseline or screening mammogram when the provider accepts assignment. For a covered diagnostic mammogram, the Part B deductible applies and you generally pay 20 percent of the Medicare-approved amount. A facility charge may apply in some outpatient settings.
Medicare Advantage
A Medicare Advantage plan must cover Medicare-covered mammography services. The plan may have network, referral, or prior authorization rules. Check the plan before scheduling a non-emergency diagnostic test.
What to do next
- Ask whether the appointment is screening or diagnostic.
- Ask the imaging facility whether it accepts Medicare assignment.
- Confirm that a requested 3D mammogram will be billed with the proper mammography service.
- Check your plan if you have Medicare Advantage.
Coverage is determined from the claim, the patient’s eligibility, provider status, and applicable Medicare rules. A provider’s recommendation does not guarantee payment. Before a planned service, ask the provider what will be billed and ask Medicare or the plan whether any coverage review is required.
Sources
Last reviewed: August 2026. Medicare rules and plan benefits can change.