What is the Medicare 12 Month Rule for Mammograms?


Mammograms are very important for all women to get, especially women who are over the age of 30 due to the prevalence of breast cancer.  To try to fight and prevent this ugly disease most health insurance companies will allow for some screenings to be done without charge.  This preventive screening is also covered by Medicare but there are a few restrictions you should be aware of, such as the 12 month rule.

The 12 month rule sounds much more mystical and strange than it is, because people have talked about it so much.  Basically, every covered individual under Medicare gets a mammogram covered once every 12 months.  This applies to women over the age of 40 as Medicare just covers one baseline mammogram for women that are between the ages of 35 and 39.

If your mammogram is scheduled too soon in reference to the 12 month rule you can count on it being denied.  The 12 month period begins in the month after the month in which you had a mammogram performed.  What this means is that you cannot have another mammogram that is covered by Medicare until the same month in the next calendar year.


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