A routine screening mammogram is covered at 100% under the ACA with no cost-sharing. Until it isn't. The transition from preventive to diagnostic can happen mid-appointment, and many women find out when a bill arrives weeks later.
When your screening becomes a diagnostic
If the radiologist sees something during your screening mammogram and calls you back for additional views, the follow-up appointment often bills as a diagnostic mammogram. CPT 77067 (screening) becomes CPT 77066 or 77065 (diagnostic), and your deductible and cost-sharing apply.
This is not a mistake or overcharge. It is how the coding works. The facility rates shown here are relevant even for women who expect to pay nothing, because a callback can change that.
3D mammography (tomosynthesis) bills differently
Digital breast tomosynthesis, or 3D mammography, uses CPT 77063 as an add-on code. Some insurers cover it as preventive. Others bill it as a diagnostic add-on with cost-sharing.
If your facility offers 3D mammography, ask your insurer before your appointment whether the add-on code is covered without cost-sharing under your specific plan.
You can choose your mammography facility
Mammograms are fully shoppable. The imaging quality at an accredited freestanding imaging center is equivalent to a hospital outpatient department.
For routine screening, use your insurer's provider search to find the lowest-cost in-network option. The rates in Tampa range from $187 to $1,200 at hospitals alone. Freestanding centers are typically lower still.