You do not need a referral for a screening mammogram with Original Medicare
If you have Original Medicare (Part A and Part B), you can schedule a screening mammogram directly with any radiologist or imaging center that accepts Medicare. You do not need your doctor to refer you first. Medicare covers one screening mammogram every 12 months for women 40 and older, and every two years for women 50 and older, with no referral required.
The only time a referral matters is if your doctor wants to order a diagnostic mammogram — one done because you have symptoms like a lump, pain, or discharge, or because a screening found something that needs closer look. In that case, your doctor will typically order it, but you still do not need a formal referral document to have the test done. You can call the imaging center directly and mention your doctor's name.
Key Takeaways
- Original Medicare covers screening mammograms without a referral, so you can call any Medicare-accepting imaging center and book one yourself.
- Medicare pays for one screening mammogram per year for women 40 and older, and every two years for women 50 and older.
- If your doctor orders a diagnostic mammogram because of symptoms or abnormal findings, no referral paperwork is required — just tell the imaging center your doctor's name.
- If you have a Medicare Advantage plan instead of Original Medicare, check your plan documents or call the plan directly, because referral rules vary by plan.
- Make sure the imaging center you choose is in-network for your plan to avoid surprise bills.
How screening and diagnostic mammograms differ on Medicare
A screening mammogram is a routine test for women with no symptoms. Medicare covers this without any doctor involvement. You can walk in, call ahead, or book online at any imaging center that takes Medicare. No referral, no prior authorization, no waiting for your doctor's office to send paperwork.
A diagnostic mammogram is ordered when there is a specific reason — you felt a lump, your screening found something unusual, or you have breast pain. Your doctor will typically order this, but the order does not have to be a formal referral. You can call the imaging center, give them your doctor's name and phone number, and they will contact your doctor's office to get the clinical reason for the test. Medicare will cover it the same way.
The coverage amounts are the same either way. Medicare Part B pays 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicaid policy that covers it.
What to do if you have a Medicare Advantage plan
If you chose a Medicare Advantage plan (Part C) instead of Original Medicare, the referral rules are different and depend on your specific plan. Some plans require a referral from your primary care doctor before you can have a screening mammogram. Others do not. You need to check your plan's member handbook or call the plan's customer service number to find out.
Even if your plan does not require a referral, it may require prior authorization — meaning the imaging center has to get approval from your plan before the test is scheduled. This usually takes one to two business days. The imaging center will handle this step for you, but it is worth asking when you call to book whether prior authorization is needed.
Make sure the imaging center you choose is in your plan's network. If you go out of network without authorization, you may owe the full cost of the mammogram.
How to find a Medicare-accepting imaging center
Use the Medicare Provider Search tool on Medicare.gov. Go to the search page, select "Mammography" as the service type, enter your city or zip code, and the tool will show you all imaging centers in your area that accept Medicare. The results include their addresses, phone numbers, and whether they are accepting new patients.
You can also ask your primary care doctor for a recommendation. Even though you do not need a referral, your doctor may know which centers have short wait times or good reputations in your area. If your doctor recommends a specific center, mention it when you call to book.
When you call to schedule, tell them you have Medicare and ask whether they accept your specific plan (Original Medicare or your Advantage plan name). Ask about wait times for screening mammograms, whether they do digital or 3D mammography, and whether you need to bring anything besides your insurance card and photo ID.
What documents and information to bring
Bring your Medicare card and a photo ID. If you have a Medigap or Medicaid policy, bring that card too. The imaging center will copy these before your appointment.
If this is a diagnostic mammogram ordered by your doctor, bring any paperwork your doctor gave you describing the reason for the test. If you do not have paperwork, the imaging center can call your doctor's office to get the clinical reason.
Wear a two-piece outfit so you can undress only the top half. Do not wear deodorant, powder, or lotion on your chest or underarms on the day of the test — these can show up on the images and may require repeat images.
What happens after your mammogram
The radiologist will read your mammogram and send the results to your doctor within a few days to a week. Your doctor's office will contact you with the results. If the mammogram is normal, you will get a letter saying so. If something needs follow-up, your doctor will call you to discuss next steps.
You can also request your own copy of the images and the radiologist's report. Many imaging centers will give you a CD of the images at no charge, and you can pick it up the same day or have it mailed to you. This is useful if you are seeing a specialist or getting a second opinion.
Common reasons your claim might be denied
Medicare may deny a screening mammogram claim if the imaging center is not Medicare-enrolled or if you had a screening mammogram less than 12 months ago (or less than 24 months if you are under 50). Check the Medicare Provider Search tool before you book to make sure the center is enrolled.
If you have a Medicare Advantage plan and did not get prior authorization when required, your plan may deny the claim or charge you the full cost. Always confirm with your plan or the imaging center whether prior authorization is needed before your appointment.
If the mammogram is coded as diagnostic instead of screening, Medicare will explore your Part B deductible and coinsurance. This should not happen for a routine screening, but if you receive a bill that seems wrong, call the imaging center's billing department and ask them to review the claim code.
Frequently Asked Questions
Can I get a mammogram at an urgent care or walk-in clinic?
Most urgent care and walk-in clinics do not have mammography equipment. Mammograms must be done at a hospital radiology department, a dedicated imaging center, or a breast center. Use the Medicare Provider Search tool to find locations near you that offer mammography.
What if my doctor says I need a mammogram but I do not have symptoms?
If your doctor recommends a screening mammogram, you can schedule it yourself without waiting for a referral. Call a Medicare-accepting imaging center directly and book an appointment. If your doctor wants to order a diagnostic mammogram for a specific reason, they will typically send the order to the imaging center, but you can also call and mention your doctor's name.
Do I have to pay anything out of pocket for a screening mammogram?
With Original Medicare, you pay nothing if you have met your Part B deductible for the year. If you have not met your deductible, you pay the full deductible amount. After that, Medicare covers 100 percent of a screening mammogram at an in-network center. If you have a Medigap policy, it may cover your deductible.
What if the imaging center says they need a referral from my doctor?
If you have Original Medicare, you do not need a referral for a screening mammogram. Tell the center you have Original Medicare and that referrals are not required. If you have a Medicare Advantage plan, the center may be correct — some plans do require referrals. Call your plan to confirm before your appointment.
Can I get a mammogram at a different location than my primary care doctor?
Yes. You can go to any imaging center that accepts Medicare, regardless of whether your doctor has a relationship with that center. You do not need your doctor's permission or a referral to choose where you have your mammogram done.