Utah · Medicare · Mammograms, 3D, dense breasts and what a call-back costs

Does Medicare Cover Mammograms in Utah? (2026 Costs)

Yes. Medicare Part B pays for a screening mammogram every year for every woman 40 and older, 3D included, with no deductible and nothing to pay, and there is no age at which it stops. What can cost money is what comes after: a diagnostic mammogram, an ultrasound, an MRI or a biopsy is an ordinary Part B service at 20% after the $283 deductible. October is Breast Cancer Awareness Month, so here is the whole picture for a Utah retiree: the rules, what each test actually cost Utah women in CMS's own 2024 claims file, why Utah women screen less than the nation and are diagnosed later, which 73 Utah facilities are FDA-certified to do the test, and how a Medigap policy or a Medicare Advantage plan handles each bill.

Three retired women in their seventies walk and talk together along a sunny garden path, one pushing a rollator, the kind of friends who remind each other that a Medicare-covered screening mammogram is due every year for Utah women.

The bottom line

  • A screening mammogram is $0 every 12 months from age 40, for life. Part B waives the deductible and the 20%, the 3D (tomosynthesis) add-on is covered the same way, no doctor's order is needed, and there is no upper age limit. In 2024 Medicare paid 100% of the approved amount on all 30,381 Utah screening mammograms in its claims file. A baseline mammogram between 35 and 39 is also covered once.
  • Everything after the screening costs 20% after the $283 deductible. At 2024 Utah averages a call-back work-up (diagnostic mammogram with 3D plus a limited ultrasound) was $252.95 in approved charges, $50.59 at 20% but the whole amount if your deductible is not yet met. An ultrasound-guided biopsy in a hospital outpatient department was about $1,592.88 between the radiologist and the hospital, $319 to you; in an imaging office it was a single $403.05 fee, $81 to you. Medigap Plans G and N pay the 20%.
  • Utah women on Medicare screen less than the nation. 30,381 Utah women in Original Medicare had a screening mammogram in 2024, 16.56% of everyone with Part B in Original Medicare against 20.35% nationally, 0.81 times the national rate; counting only women, roughly 31.3% against 37.4%. The CDC's survey of women 50 to 74 says the same: 72.1% of Utah women had a mammogram in the past two years against 76.5% nationally, with 28 of 29 counties below the national figure.
  • Utah has slightly less breast cancer than the nation and finds it later. 126.3 new cases per 100,000 women a year against 133, but 33.6% of Utah cases are regional or distant when found, against 30.7% nationally, and Utah's death rate is higher (19.9 vs. 18.9 per 100,000; 99.1 vs. 90.2 among women 65 and older). Among women 65 and older Utah's rate is now above the nation's and rising 2.2% a year.
  • 73 Utah facilities hold the FDA certificate Medicare requires, including hospitals in Moab, Blanding, Panguitch, Vernal, Price and Richfield and a mobile unit, and 449 of Utah's 466 Medicare-enrolled diagnostic radiologists (96%) accept assignment, so the $0 is real almost everywhere in the state. In Medicare Advantage the screening is $0 too, but the work-up and biopsy carry the plan's copays and, often, prior authorization.

Mammography is the oldest preventive benefit in Medicare and the simplest. Congress added screening mammograms to Part B in 1991 and, in the Balanced Budget Act of 1997, made them annual from age 40 and waived the deductible; the Affordable Care Act later removed the coinsurance. Medicare.gov's mammogram page today says Part B “covers baseline, screening, and diagnostic mammograms,” that for baseline and screening mammograms “you pay nothing for the test if provider accepts assignment,” and that for diagnostic mammograms, “after you meet the Part B deductible, you pay 20% of the Medicare-approved amount.” That one distinction, screening versus diagnostic, decides every bill in this article. A screening mammogram is the yearly test on a woman with no symptoms. A diagnostic mammogram is one ordered because of a lump, a nipple change, a history of breast cancer or something the radiologist saw on the screening, and it, along with the ultrasound, the MRI and the biopsy that may follow, is paid the way Medicare pays any other test: 20% after the $283 deductible in 2026.

What makes this worth a Utah article rather than a national one is the data. Utah women on Medicare get fewer screening mammograms than women elsewhere, fewer diagnostic ones and fewer ultrasounds, and Utah's breast cancers are more often found at a late stage; Utah's breast cancer death rate is above the national rate even though its incidence is below it, and among women 65 and older the incidence has now crossed above the nation's and is rising. None of that is caused by cost, because the screening is $0. Some of it is geography, some of it is the call-back bill, and some of it is simply not going. We cover each.

What does Medicare cover for breast cancer screening, and how often?

The rules below are quoted from Medicare.gov and from chapter 18 of CMS's Medicare Claims Processing Manual, which is the instruction CMS gives the contractors that pay the claims. The screening benefit is for women; a diagnostic mammogram is covered for anyone, including a man, with signs or symptoms. “Assignment” means the facility accepts the Medicare-approved amount as payment in full.

TestWhoHow often Medicare covers itWhat you pay (provider accepts assignment)
Baseline mammogramWomen 35–39Once, between the 35th and 40th birthdays$0: no deductible, no coinsurance
Screening mammogram (77067), 2D, both breastsWomen 40 and older, no symptoms; no doctor's order requiredOnce every 12 months: CMS counts from the month after the last one and pays again once 11 full months have passed, so a January 2026 mammogram can be repeated in January 2027$0: no deductible, no coinsurance, no age limit
Screening 3D mammogram (tomosynthesis, 77063)Same women, billed with the screening mammogramSame schedule$0: CMS's manual says “beneficiary coinsurance and deductible do not apply” to the 3D add-on
Diagnostic mammogram (77066 both breasts, 77065 one breast) and diagnostic 3D add-on (G0279)Anyone with signs or symptoms, a history of breast cancer, or a finding the doctor considers significantAs often as medically necessary, including the same day as a screening (modifier GG: the screening stays $0, the extra views are diagnostic)20% after the $283 deductible; paid under the physician fee schedule in every setting, so a hospital does not change the price
Breast ultrasound (76642 limited, 76641 complete)When a provider orders it after a mammogram to check a specific areaWhen medically necessary; not covered as a routine screening for dense breasts20% after the deductible
Breast MRI (77049)When medically necessary (e.g., a known cancer, a very high inherited risk, implants)When medically necessary; not a Medicare screening benefit20% after the deductible
Image-guided breast biopsy (19083 ultrasound, 19081 stereotactic, 19085 MRI), with marker clipWhen a finding needs tissueWhen medically necessary20% of the radiologist's fee and 20% of the facility fee (hospital outpatient) or 20% of one global fee (imaging office), after the deductible; the pathology lab bills separately at 20%

Sources: Medicare.gov, Mammograms; CMS, Medicare Claims Processing Manual, chapter 18, section 20 (screening frequency, baseline rule, deductible waiver, 3D add-on codes 77063 and G0279, modifier GG, diagnostic mammography paid under the physician fee schedule since the 2003 Medicare Modernization Act, section 644); CMS, 2026 Medicare Parts A & B Premiums and Deductibles — medicare.gov, cms.gov (PDF), cms.gov.

Two things about the schedule are worth knowing. First, Medicare's screening is yearly and has no end date, while the U.S. Preventive Services Task Force's 2024 recommendation is a mammogram every two years from 40 to 74, with the evidence for women 75 and older rated “insufficient.” Medicare will pay for the yearly test at 80 if you and your doctor want it; it does not require it. Second, the FDA's rule that took effect September 10, 2024, requires every mammography facility to tell you in your results letter whether your breasts are dense, with the sentence “Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer.” About half of women over 40 will get that letter. What it does not do is create a Medicare benefit: the Task Force rates supplemental ultrasound or MRI for dense breasts “insufficient” too, so Medicare covers those only when a doctor orders them as medically necessary, at 20%, not as a $0 screening. If you have dense breasts, the conversation to have is with your doctor about your overall risk, and the 3D mammogram, which is $0, is the one supplemental tool Medicare does pay for as a screening.

What do you pay for a mammogram with Medicare in 2026?

Nothing for the screening, and CMS's claims file proves it in the same way it did for colonoscopies: for the Utah screening mammogram code and for the 3D add-on, in both the office and the hospital setting, the average amount Medicare paid in 2024 equals the average amount it approved, to the cent. There was no deductible and no 20% on any of 30,381 Utah screening mammograms. The money starts with the second test. A radiologist who sees something on the screening orders a diagnostic mammogram, usually with 3D, and often a targeted ultrasound the same visit; if that shows a solid finding, a biopsy follows, usually guided by ultrasound, in a hospital outpatient department or an imaging office. Each of those is a Part B service at 20% after the $283 deductible, and because most screening mammograms happen early in the year, the call-back is frequently the first Part B bill of the year and goes entirely to the deductible.

$0
a screening mammogram with 3D, in any setting: Medicare paid 100% of the approved amount ($91.85 + $38.00, 2024 Utah averages) on every Utah screening claim
$51
your 20% of a call-back work-up, a diagnostic mammogram of both breasts with 3D ($133.66 + $41.85) and a limited ultrasound ($77.44), $252.95 in all; the full $252.95 if your deductible is not yet met
$319
your 20% of an ultrasound-guided biopsy in a Utah hospital outpatient department: the radiologist's $141.88 plus the hospital's $1,451.00 average facility fee (APC 5072), before the pathology bill
$81
the same biopsy in an imaging office, where it is one global fee of $403.05: the building matters for the biopsy, not for the mammogram

Sources: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024, Utah office and facility rows for 77067, 77063, 77066, G0279, 76642 and 19083; CMS, Medicare Outpatient Hospitals by Geography and Service, 2024, Utah APC 5072 line for 19083 — data.cms.gov (physicians), data.cms.gov (outpatient hospitals).

Why the building does not matter for the mammogram itself is a quirk worth knowing. In 2003 Congress moved diagnostic mammography out of the hospital outpatient payment system and onto the physician fee schedule, so a hospital's diagnostic mammogram is approved at the same amount as an imaging center's; the 2024 Utah average of $133.66 for both breasts is the whole test wherever it is done. A biopsy is different. In a hospital outpatient department Medicare pays the radiologist a $141.88 fee and the hospital a separate facility fee that averaged $1,451.00 in Utah in 2024 ($1,538.44 nationally for the same payment group), while in an imaging office the entire procedure is one $403.05 fee. The 557 Utah women whose ultrasound-guided biopsy was done in a hospital in 2024 therefore owed about $319 for it, and the 100 whose biopsy was done in an office owed about $81, for the same needle and the same marker clip. Most Utah biopsies are in hospitals because that is where most Utah mammography is: 78% of Utah screening mammograms in 2024 were read in a facility setting, against 50% nationally, a reflection of how much of Utah's imaging runs through Intermountain Health and University of Utah Health hospital departments.

Service (code)2024 Utah average Medicare-approved amountYour share in 2026, Original Medicare, deductible already met
Screening mammogram, 2D (77067)$91.85$0.00
Screening 3D add-on (77063)$38.00$0.00
Diagnostic mammogram, both breasts (77066)$133.66$26.73
Diagnostic mammogram, one breast (77065)$104.27$20.85
Diagnostic 3D add-on (G0279)$41.85$8.37
Breast ultrasound, limited (76642)$77.44$15.49
Breast ultrasound, complete (76641)$117.99$23.60
Breast MRI, both breasts (77049)$275.34$55.07
Ultrasound-guided biopsy, imaging office, global (19083)$403.05$80.61
Ultrasound-guided biopsy, hospital outpatient: radiologist $141.88 + facility $1,451.00$1,592.88$318.58
Stereotactic biopsy, hospital outpatient: radiologist $151.35 + facility $1,435.73$1,587.08$317.42

Averages across all Utah claims for each code in 2024, office (global) row unless noted; hospital facility amounts are the Utah average approved amount on the APC 5072 line for each biopsy code. Not price quotes; the pathology lab's examination of the tissue is a separate claim at 20%. A non-participating provider may charge up to 15% above these amounts. Sources as above.

How many Utah women on Medicare get mammograms, and how does Utah compare?

Fewer than elsewhere, at every step. CMS's file of Original Medicare claims counts 30,381 Utah beneficiaries with a screening mammogram in 2024, 16.56% of everyone with Part B in Original Medicare, against 20.35% nationally, 0.81 times the national rate. Because the benefit is for women, the better denominator is women: applying the female share of Utah's Medicare population (53.0%) to Part B Original Medicare enrollment gives roughly 97,209 Utah women, of whom about 31.3% had a screening mammogram in the year, against about 37.4% nationally. A yearly rate in the thirties is not alarming by itself, since the Task Force's schedule is every two years and the file counts a single year, but Utah's gap with the nation is consistent across the file, and it was there in 2022 too (15.88% vs. 19.31%).

Service (code)Utah beneficiaries, 2024Share of Utah Part B (Original Medicare)Share, U.S.Utah ÷ U.S.Utah clinicians billing
Screening mammogram (2D, both breasts) (77067)30,38116.56%20.35%0.81343
Screening 3D mammogram add-on (tomosynthesis) (77063)29,50716.08%19.53%0.82—
Diagnostic mammogram, both breasts (77066)1,6460.90%1.88%0.48—
Diagnostic mammogram, one breast (77065)2,3521.28%1.96%0.66—
Breast ultrasound, limited (76642)2,8471.55%2.03%0.76—
Breast MRI, both breasts, with contrast (77049)4710.26%0.45%0.57—
Breast biopsy, ultrasound-guided, with marker (19083)5800.32%0.37%0.86—
Breast biopsy, stereotactic (mammogram-guided), with marker (19081)2490.14%0.19%0.71—
Lumpectomy (partial mastectomy) (19301)4070.22%0.20%1.13—
Simple mastectomy (19303)1390.08%0.06%1.24—

Distinct Original Medicare beneficiaries with each service billed by a Utah clinician in 2024, facility and office rows combined; a person can appear under more than one code. Shares are of all people with Part B in Original Medicare (men included), Utah 183,494 and U.S. 27,982,142, so the ratio column is the like-for-like comparison. Source: CMS, Medicare Physician & Other Practitioners — by Geography and Service, 2024; CMS, Medicare Monthly Enrollment.

Share of people with Part B in Original Medicare who had each service billed in 2024; Utah bars solid, national bars lighter; bars scaled to the largest value. Source: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024.

The pattern is the opposite of the one in our colonoscopy guide. Utah runs 0.81 times the national rate for screening mammograms, 0.57 times for diagnostic mammograms and 0.50 times for breast ultrasounds, yet 1.13 times the national rate for lumpectomies and 1.24 times for mastectomies. Fewer tests and more surgery per beneficiary is consistent with the registry figures in the next section: Utah women 65 and older now have slightly more breast cancer than the nation, and more of it is found late. One number in the table is reassuring: 97.1% of Utah screening mammograms included the 3D add-on, against 96.0% nationally, so the better test is the standard test here, at no extra cost.

The CDC's county survey says the same thing about the women just below and just above 65. PLACES estimates the share of women 50 to 74 who had a mammogram in the past two years, and the population-weighted figure for Utah's 29 counties is 72.1%, against 76.5% nationally; 28 of 29 counties are below the national figure and only Summit County, at 76.6%, is above it. The lowest are San Juan (61.6%), Duchesne (61.9%), Grand (63%) and Uintah (63.5%), all of which have an FDA-certified facility in the county, which says the gap is not only about distance.

Why does Utah find breast cancer later, and what does the registry show?

Utah's overall breast cancer rate is modestly below the nation's: the NCI and CDC's State Cancer Profiles put age-adjusted incidence at 126.3 new cases per 100,000 women a year for 2019–2023, against 133 nationally, 0.95 times the national rate and 46th of the 50 states and the District of Columbia, with 1,952 Utah women diagnosed a year, 913 of them 65 or older. But the rate is rising 2.4% a year in Utah against 0.6% nationally, and among women 65 and older it is already above the nation, 451.9 against 446.8, rising 2.2% a year while the national figure is flat. The stage at diagnosis is the number that should concern a Utah woman: 33.6% of Utah breast cancers are regional or distant when found, against 30.7% nationally, and the death rate follows, 19.9 per 100,000 women a year against 18.9, and 99.1 against 90.2 among women 65 and older, where Utah's rate is statistically flat while the nation's is falling. 311 Utah women die of breast cancer in an average year, 195 of them 65 or older.

33.6%
of Utah breast cancers are found at a late (regional or distant) stage, against 30.7% nationally: a lower screening rate shows up as a later diagnosis
451.9
new cases per 100,000 Utah women 65 and older a year, now above the national 446.8 and rising 2.2% a year
99.1
breast cancer deaths per 100,000 Utah women 65 and older, 2020–2024, against 90.2 nationally; Utah's rate is stable while the nation's is falling
1,952
Utah women diagnosed a year on average, 913 of them 65 or older, and 311 deaths a year

Source: National Cancer Institute and CDC, State Cancer Profiles, female breast cancer, age-adjusted incidence 2019–2023 (all ages, ages 65+, and late stage) and death rates 2020–2024, November 2025 data submission — statecancerprofiles.cancer.gov.

The county table pairs each county's two-year mammography rate with its breast cancer rate and its late-stage share. The counties with the lowest screening rates are the rural ones in the east and southeast, and where the registry has enough cases to report a stage, those counties also have the highest late-stage shares: Carbon (45.9%), Tooele (40.3%), Grand (38.6%), Duchesne (38.5%) and Uintah (38%), against 25.8% in Summit County, which has the state's highest screening rate and its highest incidence, the combination you would expect where more cancers are found early.

CountyWomen 50–74 with a mammogram in 2 years, % (2022)Breast cancer cases per 100,000 women, 2019–2023Late-stage shareCountyWomen 50–74 with a mammogram in 2 years, % (2022)Breast cancer cases per 100,000 women, 2019–2023Late-stage share
San Juan61.6%102.5suppressed Emery 72.0% 99.0 suppressed
Duchesne61.9%134.238.5% Cache 72.1% 107.9 32.1%
Grand63.0%142.638.6% Davis 72.2% 124.7 33.0%
Uintah63.5%103.838.0% Morgan 72.4% 75.7 suppressed
Box Elder65.7%119.135.8% Wasatch 73.0% 132.5 29.4%
Sanpete66.2%120.731.8% Carbon 73.2% 116.4 45.9%
Piute66.7%suppressedsuppressed Washington 73.2% 123.7 31.9%
Garfield68.3%125.2suppressed Sevier 73.6% 76.6 35.2%
Iron68.3%104.537.1% Beaver 73.7% suppressed suppressed
Millard68.5%112.1suppressed Salt Lake 74.0% 133.4 32.3%
Tooele69.1%119.440.3% Kane 74.1% 120.7 suppressed
Utah69.4%130.035.7% Weber 74.9% 115.2 36.2%
Wayne71.3%suppressedsuppressed Rich 75.3% suppressed suppressed
Daggett71.4%suppressedsuppressed Summit 76.6% 155.0 25.8%
Juab71.6%152.3suppressed

Screening: women 50 to 74 who report a mammogram in the past two years, crude (not age-adjusted) model-based estimates from the 2022 Behavioral Risk Factor Surveillance System, sorted lowest to highest; the United States figure is 76.5% and Utah's population-weighted figure is 72.1%. Cancer: age-adjusted female breast cancer incidence per 100,000 and the share of cases diagnosed at a regional or distant stage, 2019–2023; “suppressed” = 3 or fewer cases a year. Sources: CDC PLACES, county data, 2025 release — data.cdc.gov; NCI/CDC State Cancer Profiles, Utah counties — statecancerprofiles.cancer.gov.

Where can a Utah woman get a Medicare-covered mammogram, and who reads it?

Almost anywhere in the state, which is unusual for a Medicare screening. Medicare pays only facilities that hold a current certificate under the federal Mammography Quality Standards Act, and the FDA's facility database lists 73 with a Utah address. They cluster along the Wasatch Front, as everything does, but they include the community hospitals in Moab, Blanding, Panguitch, Price, Vernal, Roosevelt, Richfield, Nephi, Delta, Fillmore, Gunnison, Mt. Pleasant, Tremonton and Tooele, a clinic in Montezuma Creek in the Navajo Nation, and an Intermountain Health mobile mammography unit based in Salt Lake City that travels. Compare that with the ten towns, Moab, Vernal, Price and Richfield among them, in which no gastroenterologist is listed for a colonoscopy, or the handful of cities with a Medicare-enrolled dermatologist, and mammography is the Medicare screening a rural Utah woman is least able to blame on distance.

AreaFDA-certified mammography facilities (Oct. 2026)
Salt Lake County (Salt Lake City, Murray, Sandy, Draper, Riverton, South Jordan, West Jordan, West Valley City, Holladay, Magna, Midvale)22
Utah County (Provo, Orem, American Fork, Lehi, Lindon, Payson, Salem, Spanish Fork)13
Davis and Weber counties (Bountiful, Farmington, Layton, Roy, Ogden, North Ogden)12
Washington and Iron counties (St. George, Hurricane, Cedar City)4
Cache and Box Elder counties (Logan, North Logan, Providence, Brigham City, Tremonton)5
Summit, Wasatch and Tooele counties (Park City, Heber, Tooele)4
Uintah Basin and Castle Country (Vernal, Roosevelt, Price)3
Central Utah (Nephi, Delta, Fillmore, Gunnison, Mt. Pleasant, Richfield)6
Southeastern and south-central Utah (Moab, Blanding, Montezuma Creek, Panguitch)4

Facilities with a Utah address holding a current FDA mammography certificate, grouped by area by the Data Desk; one certified facility can be a hospital, an imaging center, a clinic or a mobile unit, and the count does not measure capacity. No facility is listed with an address in Kanab, Escalante, Green River or Monticello; Kane and Garfield County residents are served from Panguitch, Cedar City or St. George. Source: FDA, Mammography Facilities database, searched by state — accessdata.fda.gov.

The reading is a separate question from the building. A mammogram taken in Blanding may be read by a radiologist in Salt Lake City, and the radiologist bills Medicare for the interpretation; in 2024, 77 Utah clinicians billed the reading of a screening mammogram in a facility setting and 266 billed the whole test from an office. CMS's clinician file lists 466 clinicians with a Utah practice location whose primary specialty is diagnostic radiology, and 449 of them, 96%, accept assignment; the other 17 are non-participating and may charge up to 15% more than the approved amount on a diagnostic reading; Medicare.gov's $0 for a screening assumes the provider accepts assignment. You will rarely choose your radiologist, so the practical check is the facility's: ask whether it accepts Medicare assignment, which every hospital-based department does.

How do Medicare Advantage and Medigap each handle a mammogram and what follows?

More than half of Utah's Medicare population, 269,226 of 490,235 people in June 2026 (54.9%), is in a Medicare Advantage plan. Medicare.gov's rule is that these plans must cover everything Original Medicare covers, so the yearly screening mammogram, 3D included, is covered, and a Medicare-covered preventive screening in network is the plan's $0 benefit too. The differences start with the call-back. A diagnostic mammogram, an ultrasound and an MRI fall under the plan's copay for outpatient diagnostic imaging, which is a flat amount per test rather than 20% and differs by plan and by the kind of imaging, with an MRI usually priced well above a mammogram; a biopsy falls under the plan's outpatient surgery or diagnostic procedure copay, which can be in the hundreds, and the MRI and sometimes the biopsy may need prior authorization. The facility must be in the plan's network, and in an HMO you may need a referral for the diagnostic work-up even though you did not need one for the screening. Read the Evidence of Coverage lines for “diagnostic radiology services,” “diagnostic tests and procedures” and “outpatient hospital services,” because that is where a Medicare Advantage breast work-up is priced.

In Original Medicare with a Medigap policy, each bill is the Medicare amount described above, and the policy pays it. Plan G pays the 20% on the diagnostic mammogram, the ultrasound, the MRI, the radiologist, the facility and the pathology, and any excess charge, leaving you the $283 Part B deductible once a year; a pure screening never touches it. Plan N pays the same except a copay of up to $20 for an office visit, which a mammogram is not, and it does not cover excess charges, which matter only with the 17 non-participating radiologists. Our Plan G vs. Plan N guide works through the difference, and the Medigap vs. Medicare Advantage guide covers the bigger choice. For a woman with a history of breast cancer, dense breasts and a yearly diagnostic work-up, or a known high-risk mutation that brings a yearly MRI, the predictability of Plan G is the argument; for a woman whose yearly screening is all she expects, it is a small part of the decision.

A St. George example: a screening that led to a biopsy

Consider a 68-year-old retired school secretary in Washington County, in Original Medicare without a Medigap policy, who has her yearly screening mammogram with 3D at one of the county's 4 certified facilities in January. The radiologist sees an area that needs a closer look and calls her back the following week for a diagnostic mammogram of both breasts with 3D and a limited ultrasound of the area, which shows a small solid mass. An ultrasound-guided biopsy with a marker clip is scheduled in the hospital's outpatient department. It is January, so nothing has been applied to her $283 Part B deductible yet.

StepMedicare-approved amountYour share in 2026 (Original Medicare, no Medigap)
Screening mammogram with 3D (77067 + 77063), Utah 2024 average$129.85$0.00 (screening)
Diagnostic mammogram, both breasts, with 3D (77066 + G0279)$175.5120% after the deductible
Limited breast ultrasound (76642)$77.4420% after the deductible
Radiologist's fee, ultrasound-guided biopsy with marker (19083)$141.8820% after the deductible
Hospital outpatient facility fee for the biopsy (APC 5072), Utah 2024 average$1,451.0020% after the deductible
Total (pathology lab's fee not included)$1,975.68$595.57: the $283 deductible plus 20% of the remaining $1,562.83; $369.17 if the deductible had already been met

Illustrative; averages across all Utah claims for each code in 2024 and the Utah average hospital outpatient facility amount on the APC 5072 biopsy line, not a price quote. Sources: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024; CMS, Medicare Outpatient Hospitals by Geography and Service, 2024; CMS Claims Processing Manual, chapter 18.

Had the screening been clean, the only line would have been the first one, at $0.00. Had the biopsy been done in an imaging office rather than the hospital, the last two lines would have been one $403.05 global fee and her total about $357.60. With Plan G she owes the $283 deductible and nothing else; with Plan N the same, plus up to $20 if a surgeon's office visit follows. In a Medicare Advantage plan she owes the plan's diagnostic-imaging copays for the mammogram and ultrasound and its outpatient procedure copay for the biopsy, which could be less or more than $595.57 depending on the plan, and the biopsy may have needed authorization. If the biopsy finds cancer, the lumpectomy ($500.85 surgeon's fee, 2024 Utah average, plus a facility fee), radiation and any drug therapy follow under the same 20% rule, and that is the year a Medigap policy or a Medicare Advantage plan's out-of-pocket maximum earns its keep.

What should a Utah woman on Medicare actually do?

  1. Book the screening every 12 months and let the facility bill it as a screening. No order is needed, no deductible applies and the 3D add-on is $0. If a bill arrives for a screening mammogram, call the facility; a screening cannot carry cost-sharing at a facility that accepts assignment, whatever the result.
  2. Expect the call-back to cost money, and know roughly how much. A diagnostic mammogram with 3D and an ultrasound is about $252.95 in approved charges at 2024 Utah averages: $50.59 if your deductible is met, all of it if not. Being called back is common and usually ends with nothing found; the bill is the price of the look, not a sign of cancer.
  3. If a biopsy is needed, ask where it will be done. The same ultrasound-guided biopsy cost an Original Medicare patient about $319 in a Utah hospital outpatient department in 2024 and about $81 in an imaging office. Your radiologist's judgment about where it should be done comes first, but the question is fair to ask, and in a Medicare Advantage plan the copay difference may be larger.
  4. Read your results letter for the density sentence. Since September 2024 it must tell you if your breast tissue is dense. If it does, talk with your doctor about your overall risk; Medicare will pay for an ultrasound or MRI your doctor orders as medically necessary, at 20%, but there is no $0 screening ultrasound or MRI, and no one should bill one as a screening.
  5. If you are in Medicare Advantage, confirm the facility is in network before the screening and get the referral and any authorization before the work-up. The screening is $0 in network; the diagnostic mammogram, ultrasound, MRI and biopsy carry the plan's copays, and the MRI in particular is frequently a prior-authorization item.
  6. Use the yearly Wellness visit to put the mammogram on the calendar. Medicare pays for a yearly Wellness visit in which the doctor writes down the screenings you are due for; the mammogram, with the date of the last one, belongs on that list. Past 75, discuss with your doctor whether to continue; Medicare will pay either way.
  7. If you live in San Juan, Duchesne, Grand or Uintah County, go anyway. Those counties have the lowest screening rates in the state and, where the registry can report it, the highest late-stage shares, and each has a certified facility in the county. The drive is short; the difference between a cancer found on a mammogram and one found by hand is not.
  8. Match your coverage to the year you might have. One $0 mammogram a year is no reason to buy a Medigap policy. A history of breast cancer, a yearly diagnostic work-up, dense breasts with a doctor who orders supplemental imaging, or a high-risk mutation that brings a yearly MRI is part of the calculation, and the Annual Enrollment Period (October 15 to December 7) is the time to make it.
Not sure what your coverage would pay for a mammogram, a call-back or a biopsy?

We help Utah retirees understand what their Medicare coverage pays for, including how Medigap and Medicare Advantage each handle screenings, diagnostic imaging and the bills that come after a finding, and how it fits with long-term care protection and retirement income. Plain English, no pressure. Education, not advice. We do not offer every plan available in your area.

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Frequently asked questions

Does Medicare cover mammograms?

Yes. Medicare Part B covers one screening mammogram every 12 months for women 40 and older, one baseline mammogram for women 35 to 39, and diagnostic mammograms whenever they are medically necessary. A screening mammogram, including the 3D (tomosynthesis) version, costs nothing if the facility accepts assignment: no deductible, no 20%. A diagnostic mammogram, which is one ordered because of a symptom, a history of breast cancer or a finding on a screening, costs 20% of the Medicare-approved amount after the $283 Part B deductible in 2026. There is no upper age limit and no doctor's order is needed for the screening. In 2024, 30,381 Utah women in Original Medicare had a screening mammogram, 97.1% of them in 3D, and CMS's claims file shows Medicare paid 100% of the approved amount on every one.

How much does a mammogram cost with Medicare in Utah in 2026?

A screening mammogram is $0. The 2024 Utah average Medicare-approved amount was $91.85 for the 2D study plus $38.00 for the 3D add-on, and Medicare paid all of it. A diagnostic mammogram is where the bill starts: the 2024 Utah average was $133.66 for both breasts ($26.73 at 20%), $104.27 for one breast ($20.85), $41.85 for the diagnostic 3D add-on ($8.37) and $77.44 for a limited breast ultrasound ($15.49), all after the $283 Part B deductible, which means that early in the year a $252.95 call-back work-up can be billed to you in full. A breast biopsy is the big one: in a Utah hospital outpatient department in 2024 the facility fee averaged $1,451.00 and the radiologist's fee $141.88, so your 20% is about $319; in an imaging office the same biopsy was a single $403.05 global fee, about $81. Medigap Plan G or Plan N pays the 20%.

Is a 3D mammogram covered by Medicare?

Yes. Since January 1, 2015, Medicare has paid for digital breast tomosynthesis as an add-on to a mammogram: code 77063 with a screening mammogram, with no deductible and no coinsurance, and G0279 with a diagnostic mammogram, at the ordinary 20%. In Utah the 3D version has become the standard: 29,507 of the 30,381 screening mammograms Medicare paid for Utah women in 2024, 97.1%, included the 3D add-on, against 96.0% nationally. You should not be asked to pay extra for 3D on a screening mammogram at a facility that accepts assignment.

Does Medicare cover a breast ultrasound or MRI if I have dense breasts?

Only when a doctor orders it as medically necessary, and then at 20% after the deductible, not as a $0 screening. Since September 10, 2024, every mammography facility in the country must tell you in your results letter whether your breast tissue is dense, because dense tissue hides cancers on a mammogram and raises risk. Medicare.gov says Part B covers a breast ultrasound only when a provider orders it after a mammogram to check a specific area, and the U.S. Preventive Services Task Force rates the evidence for routine supplemental ultrasound or MRI in women with dense breasts as insufficient, so there is no Medicare screening benefit for them. In 2024, 3,042 Utah women in Original Medicare had a breast ultrasound and 471 had a breast MRI; at 2024 Utah averages your 20% is about $15.49 for a limited ultrasound and $55.07 for a bilateral breast MRI.

What happens if my screening mammogram turns into a diagnostic one the same day?

Medicare pays for both, and you pay 20% on the diagnostic part only. CMS's billing manual created a modifier (GG) precisely for the case where a radiologist sees something on a screening mammogram and takes additional diagnostic views the same day: the screening is still paid as a screening at $0, and the additional views are paid as a diagnostic mammogram subject to the deductible and 20%. The same is true of a call-back a week later. What you cannot be charged for is the screening itself, no matter what it finds.

Where can I get a Medicare-covered mammogram in rural Utah?

Medicare pays only facilities that hold a current FDA mammography certificate, and the FDA's database lists 73 of them with a Utah address, including hospitals in Moab, Blanding, Montezuma Creek, Panguitch, Price, Vernal, Roosevelt, Richfield, Nephi, Delta, Fillmore, Gunnison, Mt. Pleasant, Tremonton and Tooele, and an Intermountain Health mobile mammography unit based in Salt Lake City. That makes mammography one of the few Medicare-covered screenings a rural Utah woman can usually get in her own county, unlike a colonoscopy, for which no gastroenterologist is listed in most of those towns. CMS's clinician file lists 466 diagnostic radiologists with a Utah practice location, and 449 of them (96%) accept assignment. A reading done by a radiologist in Salt Lake City of a mammogram taken in Blanding is still $0 for a screening.

Sources

  • Medicare.gov — Mammograms (Part B covers baseline, screening and diagnostic mammograms; baseline once for women 35–39; screening once every 12 months for women 40 and older, $0 with assignment; diagnostic mammograms when medically necessary at 20% after the Part B deductible; breast ultrasound only when a provider orders it as medically necessary): medicare.gov — mammograms
  • Medicare.gov — Does your provider accept Medicare as full payment? (assignment; non-participating providers; the 15% limiting charge): medicare.gov — assignment; Compare Original Medicare & Medicare Advantage (plans must cover all Part A and Part B services; networks and referrals): medicare.gov — compare
  • CMS — Medicare Claims Processing Manual, chapter 18 (Preventive and Screening Services), section 20, Mammography Services (Screening and Diagnostic): the age and frequency table (baseline 35–39; annual over 39 once 11 full months have passed), the Balanced Budget Act of 1997 deductible waiver, “there is no Part B deductible or coinsurance for screening mammographies,” codes 77067, 77066, 77065, 77063 and G0279, “beneficiary coinsurance and deductible do not apply” to 77063, modifier GG for a screening that becomes diagnostic the same day, diagnostic mammography paid under the physician fee schedule in hospitals since the 2003 Medicare Modernization Act, section 644, and the FDA certification requirement: cms.gov — chapter 18 (PDF)
  • CMS — 2026 Medicare Parts A & B Premiums and Deductibles, November 14, 2025 (Part B premium $202.90; Part B deductible $283): cms.gov — 2026 premiums and deductibles
  • CMS — Medicare Physician & Other Practitioners — by Geography and Service, calendar years 2024 and 2022 (Utah and National rows for 77067, 77063, 77066, 77065, G0279, 76642, 76641, 77049, 19083, 19081, 19085, 19301 and 19303; beneficiaries, clinicians, average approved and paid amounts by place of service): data.cms.gov — physicians by geography and service
  • CMS — Medicare Outpatient Hospitals — by Geography and Service, calendar year 2024 (Utah and National APC 5072 rows: 557 Utah beneficiaries with an ultrasound-guided breast biopsy at an average approved facility amount of $1,451.00; 288 with a stereotactic biopsy at $1,435.73; national APC average $1,538.44): data.cms.gov — outpatient hospitals by geography and service
  • CMS — Medicare Monthly Enrollment (2024: 183,494 Utahns and 27,982,142 nationally with Part B in Original Medicare, 53.0% and 54.4% of all beneficiaries female; 2022: 197,316 and 29,655,517; June 2026: 490,235 Utah beneficiaries, 269,226 in Medicare Advantage, 221,009 in Original Medicare): data.cms.gov — monthly enrollment
  • CMS — Doctors and Clinicians National Downloadable File, retrieved October 7, 2026 (466 Utah diagnostic radiologists, 449 accepting assignment): data.cms.gov — doctors and clinicians
  • U.S. Food and Drug Administration — Mammography Facilities database (MQSA-certified facilities; 73 with a Utah address, searched October 7, 2026): accessdata.fda.gov — mammography facilities; FDA Updates Mammography Regulations to Require Reporting of Breast Density Information (final rule of March 9, 2023, effective September 10, 2024; about half of women over 40 have dense breast tissue): fda.gov — breast density rule; Understanding Breast Density: fda.gov — breast density
  • U.S. Preventive Services Task Force — Breast Cancer: Screening, final recommendation, April 2024 (biennial screening mammography for women 40 to 74, grade B; women 75 and older, grade I; supplemental ultrasound or MRI for dense breasts, grade I): uspreventiveservicestaskforce.org
  • CDC — PLACES: Local Data for Better Health, county data, 2025 release (mammography use among women 50–74, crude prevalence, 2022 BRFSS, all 29 Utah counties; United States 76.5%): data.cdc.gov — PLACES
  • National Cancer Institute and CDC — State Cancer Profiles, female breast cancer: age-adjusted incidence by state 2019–2023, all ages (Utah 126.3, U.S. 133) and ages 65+ (Utah 451.9, U.S. 446.8); late-stage incidence and share (Utah 43, 33.6%; U.S. 42.6, 30.7%); death rates 2020–2024, all ages (Utah 19.9, U.S. 18.9) and 65+ (Utah 99.1, U.S. 90.2); Utah counties: statecancerprofiles.cancer.gov — Utah counties, statecancerprofiles.cancer.gov — death rates
  • Utah Insurance Department — Medicare consumer page (Utah SHIP (877) 424-4640): insurance.utah.gov

About this article. Written by the Utah Retirement Income Data Desk and reviewed by Brian Penner, Retirement income & long-term care planner. Educational only — not medical, financial, or legal advice, and not a recommendation of any specific plan, provider, facility, laboratory or test; whether, when and how often to be screened for breast cancer, and what to do about a finding, is a decision for you and your doctor. Coverage rules and cost-sharing are quoted from Medicare.gov, CMS, the FDA and the U.S. Preventive Services Task Force as of October 7, 2026; the Utah and national beneficiary counts, shares and average amounts are our own tabulation of the CMS Physician & Other Practitioners, Outpatient Hospitals, Doctors and Clinicians and Medicare Monthly Enrollment public use files, which count Original Medicare claims only, attribute each claim to the state of the clinician or hospital, and are revised by CMS periodically; a person can appear under more than one billing code; the per-woman screening rate applies the female share of all beneficiaries to Part B Original Medicare enrollment and is an estimate; the county screening figures are CDC model-based estimates and the cancer figures are registry rates, each with the limitations noted on its source page; the facility count is the FDA database as searched on that date. Average Medicare-approved amounts are averages across all claims and are not price quotes; Medicare Advantage copay descriptions are general and vary by plan; the example household is illustrative. What you will owe depends on your coverage, your doctor, the facility, how the test is ordered and billed, and whether each provider accepts assignment or is in your plan's network; confirm with your plan, your provider, or 1-800-MEDICARE before you act. Utah Retirement Income is a licensed independent insurance agency (NPN 16493717) and is not a government agency; we are not connected with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the National Cancer Institute, the Food and Drug Administration, the Social Security Administration, or any government program, and nothing here should be read as an endorsement by them. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area; please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program — in Utah, the Utah SHIP at (877) 424-4640 — to get information on all of your options. A $0-premium Medicare Advantage plan is not free; you still pay the Part B premium ($202.90 a month in 2026 for most people) and the plan's cost-sharing. Long-term care insurance and annuity guarantees depend on the claims-paying ability of the issuing company, with no promise of savings. If you call or text us, you consent to be contacted at the number you provide about your options; message and data rates may apply, and you can opt out at any time by replying STOP.