Does Medicare Cover a 3D Mammogram? 

Mammograms are used across the world to screen women for diseases of the breast. More specifically, a mammogram can be used to look for signs of breast cancer. While each woman’s schedule differs based on medical need, mammograms are generally recommended annually for women over the age of 40. Early detection is one of the leading factors in the successful treatment of breast cancer, and some women are at a greater risk of developing breast cancer, including those who have a family history of the disease.

How does a mammogram work?

During a mammogram procedure, an imaging machine is used to compress each breast and take x-rays of the tissue. These x-ray images can detect calcification and other abnormalities that may indicate disease. While a mammogram alone is not enough to diagnose breast cancer, it is one of the tools used to arrive at a diagnosis alongside blood tests, biopsy and clinical examination data.

What is a 3D mammogram?

The traditional mammogram only produces medical imaging in two dimensions, but advances in technology now allow for 3D mammograms to be performed. A 3D mammogram is similar to a traditional exam in that each breast is compressed so that x-rays can be taken.

The difference in a 3D mammogram is that the mammogram machine rotates the x-ray emitter around the breast while taking multiple images. These images are then combined using software to form a three-dimensional image of the breast tissue. The benefit of 3D mammography is that it may be able to provide a more detailed analysis of the size, shape and location of any abnormalities.

Medicare mammogram coverage

Before examining whether Original Medicare covers 3D mammograms, it’s first important to point out that there are two types of mammograms that Medicare considers. A screening mammogram is one that is conducted annually to check for breast cancer. A diagnostic mammogram is one that is used when breast cancer is suspected or when treatment for diseases of the breast tissue has been administered.

Original Medicare covers screening mammograms for Medicare recipients over the age of 40 once per year. Original Medicare will also cover diagnostic mammograms as needed as long as the procedure is medically necessary as ordered by a Medicare-participating physician.

Does Medicare cover a 3D mammogram?

In most cases, Medicare covers 3D mammograms just like it covers traditional mammograms. This means that women over the age of 40 can receive screening procedures once per year and diagnostic testing more often when ordered by a doctor.

Medicare coverage for 3D mammograms typically falls under Medicare Part B, the outpatient benefit. If a 3D mammogram is administered as part of your treatment while admitted to a hospital or skilled nursing facility, Medicare Part A, the inpatient benefit, will supply coverage. Medicare Part D, the prescription drug benefit, does not apply to mammography, but it may provide coverage for medications used in the treatment of diseases found through mammogram screening.

In terms of cost, 3D mammograms tend to be more expensive than traditional mammograms. This means that you may end up with a higher coinsurance cost even with Medicare benefits covering 80% of the bill in the traditional split found in Medicare coverage under Part B.

Are 3D mammograms covered by Medicare Advantage plans?

Medicare Advantage plans should provide the same coverage as Original Medicare benefits when it comes to 3D mammograms. This is because Medicare Advantage plans are required to provide the same level of coverage as Original Medicare, but plan providers have more flexibility to offer additional benefits outside of those offered by Original Medicare.