Yes, a screening mammogram is considered preventive care under federal law. The Affordable Care Act requires most health plans to cover screening mammograms at no cost to you, meaning no copay, no coinsurance, and no deductible. Medicare Part B also covers screening mammograms with zero out-of-pocket cost. But the key word here is “screening.” Once a mammogram shifts from screening to diagnostic, the cost protections change significantly.
What Makes a Mammogram “Preventive”
A mammogram qualifies as preventive care when it’s a routine screening, meaning you have no symptoms and no known breast abnormalities. You’re simply checking in on your breast health as part of regular care. Under ACA plans, this type of mammogram must be covered at $0 when you use an in-network provider, even if you haven’t met your annual deductible.
The current recommendation from the U.S. Preventive Services Task Force is that all women get a screening mammogram every two years starting at age 40 and continuing through age 74. Medicare covers one screening mammogram every 12 months with no cost to you, as long as your provider accepts Medicare assignment.
When a Mammogram Stops Being “Preventive”
A diagnostic mammogram is a different billing category entirely. This type of mammogram is ordered when something needs a closer look: a lump you or your doctor found, a suspicious area on a previous screening, or symptoms like nipple discharge or breast pain. Diagnostic mammograms include more images than a standard screening and are typically more expensive. They are not guaranteed to be covered at $0 under federal law.
The nationwide average patient cost for a diagnostic mammogram is $349, though the actual amount varies wildly depending on your insurance and location. Some women pay as little as $150, while others have reported paying over $800. If an ultrasound is also needed, that adds an average of $132 in patient costs, though some plans cover it fully and others charge $755 or more.
The Callback Scenario
Here’s where many women get caught off guard. You go in for a routine, fully covered screening mammogram, and then you get called back. The moment your follow-up visit involves diagnostic imaging, your insurance may start charging you. This is one of the most common ways a “free” mammogram leads to an unexpected bill.
Getting called back after a screening mammogram is fairly common and doesn’t necessarily mean anything is wrong. Callbacks happen for several reasons:
- The initial image wasn’t clear enough
- It’s your first mammogram and there are no previous images for comparison
- You have dense breast tissue, which makes images harder to read
- A cyst showed up that looks like a mass on the mammogram
- Calcifications appeared that need a closer look
About 88% of patients who need follow-up start with a diagnostic mammogram, and roughly half of those go on to a second procedure, most often an ultrasound. Women who had additional imaging after a screening paid an average of $75 in out-of-pocket costs for breast imaging alone, compared to just $1.13 for women who didn’t need follow-up. If a biopsy is recommended based on imaging results, costs climb further.
States Are Closing the Gap
Several states have recognized that charging women for follow-up imaging after a screening discourages them from completing necessary tests. As of 2025, at least seven states have passed or enacted laws requiring insurers to cover diagnostic and supplemental breast imaging with no cost-sharing.
Arkansas now requires insurers to cover all diagnostic breast exams, including mammograms, ultrasounds, and MRIs, without copays or deductibles. The state also expanded coverage for supplemental imaging for women at elevated risk due to dense tissue, family history, or other risk factors. Colorado, Florida, and Virginia have enacted similar protections. Virginia’s law, taking effect January 1, 2026, prohibits carriers from charging copays, coinsurance, or deductibles for both diagnostic and supplemental breast imaging under individual and group plans. Oklahoma has expanded its mammography mandate to include advanced imaging like MRI and ultrasound for screening purposes.
If you live in one of these states, follow-up imaging after an abnormal screening may be fully covered regardless of whether it’s classified as diagnostic. Check your state’s insurance department website or call your insurer to confirm what applies to your plan.
How to Protect Yourself From Surprise Costs
Before your appointment, confirm that you’re scheduling a screening mammogram (not diagnostic) and that the facility is in your insurance network. Both conditions need to be true for the $0 preventive coverage to apply. If your doctor orders the mammogram because of a symptom or concern, it will likely be coded as diagnostic from the start.
If you’re called back after a screening, ask the scheduling office whether the follow-up will be billed as diagnostic and call your insurer to find out what your cost-sharing will be. Knowing in advance won’t change whether you need the test, but it prevents a surprise bill from delaying your decision to go.
For women who are uninsured or underinsured, the CDC’s National Breast and Cervical Cancer Early Detection Program provides access to screening, diagnostic, and treatment services for women with low incomes who lack adequate insurance coverage. Eligibility varies by state, and you can find your local program through the CDC’s website.