Screening Mammography, Bilateral
CPT 77067 is the standard bilateral screening mammogram, one of the most widely performed imaging tests in the U.S. with 2.8 million Medicare beneficiaries receiving it annually. Medicare pays $126.26, but providers charge an average of $324.40 (a 2.6x markup). Under the ACA, in-network screening mammograms must be covered at $0 cost sharing for women age 40 and older. If you are being charged for a screening mammogram, your insurer may be violating federal rules.
CPT 77067 at a Glance
- Average provider charge: $324.40
- Medicare rate: $126.26
- Typical markup: 2.6x over Medicare
- ACA preventive: $0 when in-network
- Setting: Same rate office and facility
- Common use: Routine breast cancer screening
- Medicare beneficiaries: 2.8 million
- 3D add-on (77063): ~$42.10 extra
Your Screening Mammogram Should Be Free
The Affordable Care Act requires most private insurance plans to cover screening mammograms with no copay, no coinsurance, and no deductible when you use an in-network provider. This applies to women age 40 and older. If you received a bill for a routine screening mammogram, contact your insurer and cite ACA preventive care requirements. The exception: if the mammogram was reclassified as diagnostic during your visit (see billing traps below), the diagnostic portion is subject to normal cost sharing.
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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). For imaging codes like 77067, the non-facility and facility Practice Expense RVUs are identical, so Medicare pays the same rate regardless of setting.
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Radiologist time, skill, and judgment | 0.74 |
| Practice Expense RVU | Mammography equipment, technologist, supplies | 2.99 |
| Malpractice RVU | Professional liability insurance | 0.05 |
| Total RVU | 3.78 | |
| x $33.4009 | 2026 conversion factor | $126.26 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). The same screening mammogram pays differently depending on your location.
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
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $128.86 | $324.40 | 2.5x |
| California (Los Angeles) | $140.83 | $324.40 | 2.3x |
| New York (Manhattan) | $141.93 | $324.40 | 2.3x |
| Florida (Fort Lauderdale) | $131.09 | $324.40 | 2.5x |
| Ohio | $117.54 | $324.40 | 2.8x |
| Mississippi | $113.13 | $324.40 | 2.9x |
| Arkansas | $112.22 | $324.40 | 2.9x |
| Alaska | $155.93 | $324.40 | 2.1x |
Rates shown use 2026 GPCIs and the $33.4009 conversion factor. For imaging codes, the Medicare physician fee is the same in office and facility settings. The average provider charge of $324.40 is the 2023 national average from CMS utilization data.
What Insured Patients Actually Pay for a Screening Mammogram
For most insured patients, a screening mammogram should cost $0 under ACA preventive care rules when performed in-network. However, the situation changes if the mammogram is reclassified as diagnostic or if additional services are billed alongside it.
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| ACA-compliant plan, in-network screening | $0 | ACA mandates $0 cost sharing for preventive screening |
| Screening converted to diagnostic during visit | $50 to $200+ | Diagnostic mammography (77066) is subject to normal cost sharing |
| 3D tomosynthesis add-on (state does not mandate coverage) | $0 to $42+ | Depends on state mandates and your plan |
| Medicare Part B | $0 | Medicare covers screening mammograms at no cost once per year for women 40+ |
Should You Use Insurance or Pay Cash?
For screening mammograms, using your insurance is almost always the better choice because ACA rules require $0 cost sharing when in-network. Cash-pay is mainly relevant for uninsured patients or those with non-ACA-compliant plans (such as health sharing ministries or short-term plans).
When Cash-Pay Makes Sense
- You are uninsured and need a screening mammogram
- Your plan is not ACA-compliant (health sharing ministry, short-term plan)
- Many imaging centers offer cash mammograms for $150 to $250
- Community programs and nonprofits may offer free or low-cost mammograms
When Using Insurance Wins
- ACA-compliant plans must cover screening at $0 in-network
- Medicare covers screening mammograms at no cost for women 40+
- Results are documented in your insurance records for follow-up care
- If a finding triggers diagnostic work, the visit is already in-network
Common Billing Problems with Mammograms
Screening reclassified as diagnostic during the visit
This is the most common mammography billing trap. You arrive for a routine screening mammogram expecting $0 cost. The radiologist sees something and orders additional views during the same visit. The facility bills the additional views as diagnostic mammography (CPT 77066), which is not covered as preventive care. You expected a $0 visit and receive a bill for $100 to $300. If this happens, ask your insurer whether the screening portion (77067) was correctly covered at $0 and whether only the diagnostic add-on is being charged.
3D tomosynthesis billed without disclosure
Many facilities now perform 3D mammography (CPT 77063) by default alongside the standard 2D mammogram. The 3D add-on has a Medicare rate of about $42.10. Some states mandate insurance coverage of 3D mammography, but others do not. If your state does not mandate coverage and your plan does not cover it, you could receive a surprise bill for the 3D component. Ask your facility before the appointment whether they plan to include the 3D add-on and whether it will be covered by your plan.
Charged for a screening mammogram that should be free
Under ACA rules, screening mammograms must be covered at $0 for women age 40 and older when performed in-network. If you receive a bill for a routine screening mammogram (CPT 77067), contact your insurer. Common causes include out-of-network billing, incorrect coding (screening coded as diagnostic), or non-ACA-compliant plans. If the facility was in-network and the mammogram was a screening, you should not owe anything for the 77067 charge.
Billed for screening mammogram before age-appropriate interval
While ACA requires coverage starting at age 40, some insurers may apply specific screening intervals (such as every 1 or 2 years). If your mammogram is denied because it was performed too soon after the last one, check your plan's specific preventive care schedule. Current USPSTF guidelines recommend screening every two years for women ages 40 to 74, but many plans cover annual screening.
Related Imaging Codes
| Code | Description | Medicare Rate |
|---|---|---|
| 77066 | Diagnostic mammography, bilateral | Higher |
| 77067 | Screening mammography, bilateral | $126.26 |
| 77063 | 3D mammography (tomosynthesis) add-on | ~$42.10 |
Frequently Asked Questions
Is a screening mammogram free under insurance?
Under the ACA, screening mammograms are covered with $0 cost sharing when performed by an in-network provider for women age 40 and older. This applies to most private insurance plans. However, if the radiologist finds something during the screening and converts it to a diagnostic mammogram, the diagnostic portion is not covered as preventive and you may owe cost sharing.
How much does a mammogram cost without insurance?
Without insurance, a screening mammogram (CPT 77067) costs $100 to $400 depending on the facility. The national average provider charge is $324.40. Medicare pays $126.26. Many imaging centers offer cash-pay mammograms for $150 to $250. Some community programs and nonprofits offer free or low-cost mammograms for uninsured patients.
What is the difference between a screening and diagnostic mammogram?
A screening mammogram (CPT 77067) is a routine preventive exam for women with no symptoms. A diagnostic mammogram (CPT 77066) is ordered when there is a symptom, a previous abnormal finding, or a recalled screening result. The key billing difference: screening mammograms are covered at $0 under ACA preventive care rules, while diagnostic mammograms are subject to your normal cost sharing (deductible, copay, or coinsurance).
Does 3D mammography (tomosynthesis) cost extra?
Yes. 3D mammography or tomosynthesis is billed separately under CPT 77063, with a Medicare rate of about $42.10. It is often billed alongside the standard 2D mammogram (77067). Some states mandate insurance coverage of 3D mammography, while others do not. Check with your insurer before your appointment if you want to know whether the 3D add-on will result in an extra charge.
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