Mammograms

Diagnostic mammography is covered when ordered by an MD/DO for patients with breast signs/symptoms, a personal history of breast cancer, biopsy-proven benign breast disease, or when an asymptomatic patient’s history and physician judgment indicate appropriateness; diagnostic exams include physician interpretation. Screening mammography coverage is age-limited: not payable for women <35, limited to one screening for women 35–39 (policy ambiguous on timing), and for asymptomatic women ≥40 is payable only if ≥11 months have passed since the prior screening; routine screening of asymptomatic women ≥50 or asymptomatic women ≥40 with mother/sister having breast cancer is considered appropriate but is not covered by Medicare.

"Diagnostic mammography is covered when ordered by a doctor of medicine or osteopathy (MD/DO) as defined in §1861(r)(1) of the Act."

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