Screening Mammography, 3D (Tomosynthesis)
CPT 77063 is the 3D mammography (tomosynthesis) add-on charge, billed in addition to the standard 2D screening mammogram (77067). Many patients do not realize they will receive two separate mammography charges for what feels like one exam. Providers charge an average of $155.45 for the 3D component alone, while Medicare pays $51.10 (a 3.0x markup). Whether your insurance covers the 3D portion at no cost depends on your state and plan.
CPT 77063 at a Glance
- Average provider charge: $155.45
- Medicare physician fee (office): $51.10
- Medicare physician fee (hospital): $51.10 + separate facility fee
- Typical markup: 3.0x over Medicare rate
- Billing type: Add-on to 2D mammogram (77067)
- Also known as: Breast tomosynthesis, 3D mammogram
- Coverage: Varies by state and plan
- Beneficiaries (2023): 2.65 million
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How the Medicare Rate Is Calculated
Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for the 77063 3D mammography add-on:
| Component | What It Covers | Office (Non-Facility) | Hospital (Facility) |
|---|---|---|---|
| Work RVU | Radiologist interpretation time | 0.59 | 0.59 |
| Practice Expense RVU | Equipment, technologist, supplies | 0.91 | 0.91 |
| Malpractice RVU | Professional liability insurance | 0.03 | 0.03 |
| Total RVU | 1.53 | 1.53 | |
| x $33.4009 | 2026 conversion factor | $51.10 | $51.10 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). For 77063, the geographic spread ranges from about $40 in lower-cost states to $48 in Alaska (a 20% difference).
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates (Office Setting)
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $43.50 | $155.45 | 3.6x |
| California (Los Angeles) | $44.56 | $155.45 | 3.5x |
| New York (Manhattan) | $45.38 | $155.45 | 3.4x |
| Florida (Fort Lauderdale) | $43.06 | $155.45 | 3.6x |
| Ohio | $41.51 | $155.45 | 3.7x |
| Mississippi | $40.29 | $155.45 | 3.9x |
| Arkansas | $40.16 | $155.45 | 3.9x |
| Alaska | $47.84 | $155.45 | 3.2x |
Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $155.45 is the 2023 national average from CMS utilization data. Actual charges vary by facility.
What Insured Patients Actually Pay for 3D Mammography
Under the ACA, screening mammography must be covered at $0 for women age 40 and older. However, whether the 3D add-on (77063) is included at no cost depends on your insurance plan and state. Here is what to expect:
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| State mandates 3D coverage | $0 | Many states require both 2D and 3D to be covered as preventive care at no cost |
| Plan covers only 2D at $0 | $50 to $155 | 3D add-on applied to your deductible or billed as a separate out-of-pocket charge |
| Coinsurance plan (deductible met) | $12 to $20 | 20% of the negotiated rate for the 3D add-on |
| Medicare Part B | $0 | Medicare covers screening mammography (including 3D) at no cost |
| Medicaid | $0 | Covered as preventive care in most states |
Should You Use Insurance or Pay Cash?
For most women, screening mammography should be $0 through insurance. The question of cash-pay arises only when your plan does not cover the 3D add-on. If that is your situation, here is how to think about it:
When Cash-Pay Wins
- Your plan does not cover 3D and would charge the full $155
- The imaging center offers a cash package for 2D + 3D at a lower combined rate
- You are uninsured and can find a center offering full mammography for $150 to $250
When Using Insurance Wins
- Your state mandates 3D coverage (most states now do)
- Your plan covers both 2D and 3D as preventive care at $0
- You have Medicare (both components are covered at no cost)
- You want the charges to count toward your deductible
Common Billing Problems with 77063
Surprise bill for the 3D add-on when you expected $0
Many patients assume their entire mammogram is free under the ACA, then receive a bill for the 3D component. This happens when the insurance plan covers only the 2D screening (77067) as preventive care and treats the 3D add-on (77063) as a separate, non-preventive charge. If this happens, first check whether your state mandates 3D coverage. If it does and your plan is state-regulated (not a self-insured ERISA plan), file a complaint with your state insurance commissioner.
Screening mammogram coded as diagnostic
Preventive screening mammograms are covered at $0, but diagnostic mammograms (ordered because of a symptom, lump, or abnormal finding) are subject to your deductible and cost-sharing. If your routine screening mammogram was coded as diagnostic (CPT 77065 or 77066 instead of 77067), you will receive a bill. Ask your provider to verify the coding if your screening was recoded as diagnostic without clear reason.
Facility fee added at hospital-based imaging center
If your mammogram is performed at a hospital-owned imaging center (even one that looks like a standalone office), you may receive a separate facility fee on top of the professional fee. This can turn a $0 screening into a $100+ bill. Independent freestanding imaging centers do not charge facility fees. If cost is a concern, verify whether the imaging center is classified as hospital-based or freestanding before scheduling.
3D performed by default without consent or cost disclosure
Many imaging centers now perform 3D mammography as the default. If you did not specifically request 3D and were not informed of the additional charge, you may have grounds to dispute the 3D add-on charge. The No Surprises Act requires providers to give good faith cost estimates for uninsured or self-pay patients. Even for insured patients, informed consent should include cost implications.
Related Mammography and Imaging Codes
Frequently Asked Questions
Why did I get two separate charges for my mammogram?
3D mammography (tomosynthesis, CPT 77063) is billed as an add-on to the standard 2D screening mammogram (CPT 77067). You will see two line items on your bill: one for the 2D images and one for the 3D component. The combined charges can exceed $300 even though the entire exam happens in a single session. This dual-billing catches many patients by surprise.
Is 3D mammography covered by insurance at no cost?
Under the ACA, screening mammography must be covered at $0 for women age 40 and older. However, some plans only cover the 2D component (77067) at no cost and treat the 3D add-on (77063) as a separate charge. More than 40 states now mandate 3D coverage, but self-insured employer plans (ERISA plans) may be exempt from state mandates. Check with your insurer before your appointment.
How much does 3D mammography (CPT 77063) cost without insurance?
Without insurance, the 3D mammography add-on costs $80 to $250 depending on the facility and location. The national average charge is $155.45, while Medicare pays $51.10. Remember this is only the 3D add-on. The 2D screening mammogram (77067) is a separate charge on top. Total out-of-pocket for both can reach $300 to $500 without insurance. Many imaging centers offer bundled cash pricing for the complete exam.
Can I decline the 3D mammogram and just get a 2D mammogram?
Yes. You can request a standard 2D mammogram only. However, 3D mammography is increasingly considered the standard of care because it improves cancer detection rates, especially for women with dense breast tissue. Many imaging centers now perform 3D by default. If cost is a concern, ask whether your insurance covers the 3D add-on before your appointment so you can make an informed decision.
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