Mammograms are classified as either screening or diagnostic. How your mammogram is classified affects your out-of-pocket cost.
Your out-of-pocket cost is what your health insurance does not cover, such as your co-insurance, co-pay, or deductible. You’re responsible for paying this cost.
What’s the difference between a screening mammogram and a diagnostic mammogram?
- Learning the difference between screening and diagnostic mammograms can help you know what to expect and avoid surprise bills.
- Your mammogram is classified after it’s done, not when it’s ordered. That means how it’s classified (and billed) may be different from why your healthcare provider first ordered it.
- It’s important to know your insurance coverage before your appointment. You may need to pay a co-pay, co-insurance, or deductible if your mammogram becomes diagnostic.
A mammogram is classified as a screening mammogram if all these are true:
- You do not have any signs or symptoms of breast problems.
- You’re having the mammogram as a routine, annual (yearly) check for breast changes.
- The mammogram does not show anything abnormal (not normal) while you’re waiting for same-day results.
Usually, there’s no out-of-pocket cost for a screening mammogram.
A mammogram is classified as a diagnostic mammogram if any of these are true:
- You have signs or symptoms of breast problems, such as a lump or nipple discharge (liquid coming from your nipple).
- You’re having the mammogram to learn more about your symptoms or past abnormal results.
- You have more than 1 mammogram in a year, even if they’re done just to check for breast changes.
- You or your healthcare provider notice a breast symptom (such as a lump) on the day of your mammogram.
- The radiologist finds something abnormal while you’re waiting for same-day results. A radiologist is a doctor with special training in using imaging to diagnose and treat disease.
You may have out-of-pocket costs for a diagnostic mammogram.
About mammograms with contrast
You may have a mammogram with contrast (special dye given through a vein). This type of mammogram is called a contrast-enhanced mammogram (CEM).
You may have out-of-pocket costs for the contrast even if your CEM is classified as a screening mammogram. Talk with your health insurance provider to learn more.
Quick guide to mammogram classification
This chart has some examples of common situations. This information does not cover every situation. It’s meant as a general guide.
| Symptoms | Reason for the mammogram | Usual cost | |
|---|---|---|---|
| Screening mammogram | No signs or symptoms of a breast problem | Routine check for breast changes | $0 out-of-pocket |
| Diagnostic mammogram | You have signs or symptoms of a breast problem | To learn about symptoms or a past abnormal result | Co-pay, co-insurance, or deductible, depending on your insurance coverage |
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