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Mammograms are the gold standard for breast cancer screening, however, they are not 100% accurate.
In some circumstances, additional imaging tests are required to decide whether a biopsy—the removal of a sample of tissue for further analysis—is required to check for malignancy.
This leads to a common question many women have which is, “does Medicare cover breast cancer screening ultrasound?” In this article, we answer the question in clear, plain English. You will also find the average costs of going through screening breast ultrasound and other helpful info.
Does Medicare Cover Breast Cancer Screening Ultrasound?
The short answer is yes; Medicare will cover the cost of screening breast ultrasounds. But not 100% of the time.
As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your screening breast ultrasound. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Breast Cancer Screening Ultrasound
Original Medicare (Medicare Part A and Part B) provides coverage for screening breast ultrasounds. Original Medicare provides coverage for screening breast ultrasounds if it is considered medically necessary. Your healthcare provider must first order the operation for Original Medicare to provide coverage.
Is it Covered by Part A or Part B?
Coverage for screening breast ultrasound is provided by Medicare Part B. Medicare Part B provides coverage for a screening breast ultrasound if you meet the following conditions:
- If you are a female with dense breasts
- If you are a female with an abnormal mammogram
- If you are a male who is at high risk or has symptoms of breast cancer
Once approved, Medicare Part B covers 80 percent of the costs of a screening breast ultrasound. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Breast Cancer Screening Ultrasound?
Medicare Advantage plans (Medicare Part C) also provide coverage for screening breast ultrasounds. These plans have to cover all the same tests, screenings, treatments and more that Original Medicare covers.
Part C plans will also cover some things that Original Medicare does not. What each plan covers and how much the out-of-pocket costs are will vary based on the plan you have.
What else does Medicare Cover for Breast Cancer Screening?
Original Medicare also provides 3D mammogram coverage. Original Medicare provides coverage for your 3D mammograms if medically necessary. Your healthcare provider must first order the screening in order for Original Medicare to provide coverage.
How Much Does Breast Ultrasound Cost?
The average cost of a breast ultrasound is around $360 in the U.S. if you have to pay out of pocket. However, depending on the facility where you get the ultrasound, the costs could reach $600 or more.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare cover gloves?