Breast
Get your mammogram fully covered (yes, really)
Last reviewed July 1, 2026
Under the Affordable Care Act, screening mammograms are covered at 100% — no copay, no coinsurance, no deductible — for women 40 and older (and earlier if high-risk). Most people don’t know this. Clinics don’t always volunteer it. Insurers routinely miscode the visit. But if you know the exact word to use when booking, you never pay a dime.
The steps
The magic word is screening. When you call to schedule, say "I’d like to book a screening mammogram", not "a mammogram," not "a diagnostic mammogram," not "a follow-up." The billing code for a screening mammogram (CPT 77067) is 100% covered by ACA-compliant insurance. The billing code for a diagnostic mammogram (CPT 77065 or 77066) is not. It goes toward your deductible.
Same machine. Same technician. Same 15 minutes. Different code, different bill.
When they check you in at the clinic, verify one more time: "This is being coded as a screening mammogram, correct?" If you have a lump, symptoms, or a callback — that’s diagnostic, and you may pay. If it’s your routine annual, it should be screening, and you should not.
This applies when
- You have ACA-compliant insurance (most plans since 2014)
- You’re 40+ and getting a routine annual mammogram
- You’re under 40 but qualify as high-risk (family history, BRCA, prior chest radiation)
- You have Medicare (screening mammograms are covered annually with no cost-sharing)
This doesn't apply when
- You have symptoms (lump, discharge, pain) — that’s diagnostic
- You’re on a "grandfathered" pre-ACA plan (rare now, but check)
- You need supplemental screening (ultrasound, MRI) — coverage varies (see dense breast guide)
- You need callback imaging after an abnormal screening — that’s diagnostic (but new 2022 federal rules require some plans to still cover it)
Resources
National Breast and Cervical Cancer Early Detection Program (NBCCEDP): Free or low-cost mammograms for women who qualify by income. Find your state’s program at cdc.gov/cancer/nbccedp or call 1-800-232-4636.
Susan G. Komen Screening Assistance: Local affiliates offer screening funds. Call the Komen Helpline at 1-877-465-6636 or visit komen.org.
American Cancer Society Road to Recovery: Free rides to screening and treatment appointments. 1-800-227-2345.
If you're denied
ACA-compliant plans cannot legally charge you for a screening mammogram (CPT 77067). If you’re billed anything, this is a coding error roughly 90% of the time. Call your insurer, cite ACA Section 2713 preventive care coverage, and ask them to reprocess the claim. Get the reference number. If they refuse, file a written appeal — most states require insurers to respond within 30 days. If that fails, file a complaint with your state insurance commissioner (contact info at naic.org).
