NCD 220.4: Mammography
Medicare covers screening mammography annually for women 40+, and diagnostic mammography when clinically indicated.
What's covered
- Annual screening mammogram for women 40+
- Baseline mammogram for women 35-39 (one in lifetime)
- Diagnostic mammogram when clinically indicated
- Digital mammography (DBT — digital breast tomosynthesis)
Coverage criteria
- Age 40+ for annual screening
- FDA-approved facility (MQSA accredited)
- Clinical indication for diagnostic mammogram
Exclusions
- More frequent screening without clinical indication
Common denial patterns
- Screening + diagnostic same day requires modifier (diagnostic mammogram on same day as screening)
- Facility not MQSA-certified
Appeal citation
NCD 220.4 (Mammography). Document age, MQSA-certified facility, screening interval, clinical indication if diagnostic.
Frequently asked questions
What does Medicare NCD 220.4 cover?
Medicare covers screening mammography annually for women 40+, and diagnostic mammography when clinically indicated.
What are the coverage criteria?
Age 40+ for annual screening; FDA-approved facility (MQSA accredited); Clinical indication for diagnostic mammogram.
What is excluded?
More frequent screening without clinical indication.
How do I cite this NCD in an appeal?
NCD 220.4 (Mammography). Document age, MQSA-certified facility, screening interval, clinical indication if diagnostic.
Sources
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