Mammograms

CMS National Coverage Determination | ncd_id=186 | manual_section=220.4 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

A diagnostic mammography is a covered service if it is ordered by a doctor of medicine or osteopathy as defined in §1861(r)(1) of the Act. Payment may not be made for a screening mammography performed on a woman under age 35. Payment may be made for only one screening mammography performed on a woman over age 34, but under age 40. For an asymptomatic woman over age 39, payment may be made for a screening mammography performed after at least 11 months have passed following the month in which the last screening mammography was performed. A radiological mammogram is a covered diagnostic test under the following conditions: A patient has distinct signs and symptoms for which a mammogram is indicated; A patient has a history of breast cancer; or A patient is asymptomatic but, on the basis of the patient’s history and other factors the physician considers significant, the physician's judgment is that a mammogram is appropriate. Use of mammograms in routine screening of: (1) asymptomatic women aged 50 and over, and (2) asymptomatic women aged 40 or over whose mothers or sisters have had the disease, is considered medically appropriate, but would not be covered for Medicare purposes.