Key takeaways

  • Medicare covers breast ultrasounds only when they are medically necessary and ordered by a doctor who accepts Medicare.
  • Medicare Part B provides coverage for one mammogram per year at no cost, but breast ultrasounds are covered only if deemed medically necessary, which means you may have to pay a copay if your test is approved.
  • In 2024, Medicare revised its coverage and no longer fully pays for breast ultrasounds when mammograms show no abnormalities except dense tissue, requiring a copay from the patient.

To screen for breast cancer, Original Medicare covers one mammogram per year at no out-of-pocket cost. But if you have denser breasts, an ultrasound may provide a more accurate diagnosis. This is because it could catch tumors that might not show up on a mammogram.

While Medicare previously offered similar coverage for breast ultrasounds as for mammograms, the program has since revised its coverage. It now covers a breast ultrasound only in certain cases when considered medically necessary.

Read on to learn about Medicare’s coverage of breast ultrasounds, the criteria for coverage, and how much the test may cost you.

In 2024, Medicare announced that it would no longer fully pay for a breast ultrasound when a mammogram shows no abnormality and the only finding is dense tissue.

This is likely because Medicare views the presence of dense breast tissue alone as insufficient to indicate a need for further screening. This doesn’t mean your test will be uncovered; you’ll only have to pay a portion of the cost as a copay.

Though ultrasounds are usually performed after a mammogram, Medicare may approve a person getting an ultrasound without a mammogram first in certain cases, but only with a doctor’s order. Plus, a qualified medical technician or doctor must perform the ultrasound.

Like mammograms, breast ultrasounds are covered under Medicare Part B. If you have a Medicare Advantage (Part C) plan instead of Original Medicare (parts A and B), your plan should similarly cover this screening. Some plans may even offer additional benefits that could reduce your costs further.

Medicare considers a breast ultrasound to be medically necessary when needed for:

  • checking for implant issues
  • planning radiation treatment
  • evaluating breast lumps in people who are pregnant or nursing
  • distinguishing between different types of masses
  • assessing the stability of a mass that is hard to see on a mammogram.

On average, people pay about $250 out of pocket for a breast ultrasound.

When Medicare Part B covers the cost, it pays 80%, and you’ll be responsible for the rest. But you have to meet a $257 first. If you haven’t met it already, you may be responsible for most of the cost.

You also have to pay a monthly premium of $185 for Part B.

If you have a Medicare supplement plan (Medigap), it can help you pay for your out-of-pocket costs.

Medicare Part B provides coverage for one mammogram per year at no cost, but breast ultrasounds are covered only if deemed medically necessary. This means you may have to pay a copay if your test is approved.

You may be able to use Medigap to help pay for the test. On the other hand, if you have Medicare Advantage (Part C), the amount you pay out of pocket will depend on the premium and deductible of your specific plan.