How does CMS define the 12 month rule for screening mammogram eligibility:QuickMedicareSupplement.com

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How do the Centers for Medicare & Medicaid Services (CMS) define the "12 month" rule for screening mammography eligibility?

How do the Centers for Medicare & Medicaid Services (CMS) define the "12 month" rule for screening mammography eligibility?

Preventive (screening) mammograms are covered once each in 12 months for all women with Medicare age 40 years and above. Medicare covers one baseline mammogram for women between age 35 years and 39 years.

Please make a note of: Medicare will deny (not pay) claims for screening mammograms performed almost immediately. To find out the 12-month period, start your count beginning with the month after the month in which a previous screening mammogram was performed. The subsequent illustrations will help you understand the 12-month rule.

Illustration 1: Mrs. Wright received a screening mammogram on February 20, 2007. She would begin counting her 12 months with March 2007, the month after the month she had her previous screening mammogram. In this example, February 2008 would be the 12th month. She is eligible to receive another screening mammogram on February 1, 2008 or later (the month after 11 full months have gone or later).

Illustration 2: Mrs. Allen received a screening mammogram on August 1, 2006. She calls her doctor's office to schedule an appointment for another screening mammogram and is offered an appointment for July 26, 2007. Mrs. Jones informs her doctor’s office that this appointment is too early to be covered by Medicare – the appointment must be in August to be covered by Medicare. Or else she may have to pay for the entire cost of the screening mammogram if she goes ahead and has the exam in July.

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