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Modifier Coding Alert

Patient Age and Frequency Requirements for Mammogram Screenings

Medicare will pay for only one screening for a woman between the ages of 35 and 39 years and they will cover screening mammograms even without a physician order for women who meet age and frequency requirements as follows:

  • For patients under age 35, there’s no payment allowed for screening mammography
  • For patients ages 35-39 the mammogram is the baseline screening and Medicare pays for only one screening mammography performed on a woman between her 35th and 40th birthday
  • For patients over age 39 Medicare will reimburse for an annual screening mammogram as long as 11 full months have elapsed following the month of last screening.

Note: Medicare does not cover screening mammography for men.