{"entity":{"id":"medicare-ncd-220-4","kind":"term","name":"Medicare NCD 220.4: mammograms","aka":["NCD 220.4","Medicare mammography coverage","Medicare screening mammography"],"tldr":"Medicare pays for a diagnostic mammogram when a doctor orders one, and for screening mammograms on a set schedule: none under 35, one between 35 and 39, and then one every year (at least 11 months apart) from age 40.","summary":"United States, Medicare National Coverage Determination 220.4, version 1; the NCD lists 15 May 1978 as its effective date and its benefit categories as diagnostic tests and screening mammography. It defines a diagnostic mammogram as one for a man or woman with signs or symptoms of breast disease, a personal history of breast cancer or of biopsy-proven benign breast disease, and a screening mammogram as one for a woman without signs or symptoms, \"at a minimum a two-view exposure (cranio-caudal and a medial lateral oblique view) of each breast\".\n\nScreening frequency, in the NCD's words: \"Payment may not be made for a screening mammography performed on a woman under age 35. Payment may be made for only one screening mammography performed on a woman over age 34, but under age 40. For an asymptomatic woman over age 39, payment may be made for a screening mammography performed after at least 11 months have passed following the month in which the last screening mammography was performed.\" A diagnostic mammogram is covered when ordered by a doctor of medicine or osteopathy, for signs and symptoms, a history of breast cancer, or an asymptomatic patient whose physician judges it appropriate.","asOf":"2026-11-04","links":[{"label":"CMS Medicare Coverage Database: the NCD","url":"https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=186&ncdver=1"},{"label":"CMS Coverage API: the NCD text as data","url":"https://api.coverage.cms.gov/v1/data/ncd?ncdid=186&ncdver=1"}],"tags":["us"],"related":[],"cancers":["breast-cancer"],"sections":[],"technologies":["mammography"],"targets":[],"drugs":[],"companies":[],"institutions":["cms"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["The NCD text ends with an older paragraph saying routine screening of asymptomatic women aged 50 and over, or 40 and over with an affected mother or sister, \"would not be covered for Medicare purposes\". It sits in the same text as the screening frequency rules quoted above and is reproduced here as written, without a reading of which governs; the screening rules are the ones the NCD's benefit category describes."],"category":"Regulation & policy"},"route":"/terms/medicare-ncd-220-4/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"}],"technology":[{"id":"mammography","kind":"technology","name":"Mammography & tomosynthesis","route":"/technologies/mammography/"}],"institution":[{"id":"cms","kind":"institution","name":"Centers for Medicare & Medicaid Services (CMS)","route":"/institutions/cms/"}]}}