Is a physician’s prescription required for Medicare to cover a screening mammography?
No, a doctor’s prescription or referral is not necessary for the procedure to be covered. Whether payment can be made is determined by a woman’s age and statutory frequency parameter. Section 4101 of the Balanced Budget Act (BBA) of 1997 provides for annual screening mammograms for women over age 39 and waives the Part B deductible. Coverage applies as follows:
- Underage 35, no payment
- From 35–39, baseline payment for only one screening mammography performed on a woman between her 35th and 40th birthday
- Overage 39, annual (11 full months have elapsed following the month of last screening)
This question was answered in our Breast & Bone Density Procedure Coding Guide. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.