Medicare Covers Ultrasound for Dense Breast Tissue When It Is Medically Necessary

Medicare Covers Ultrasound for Dense Breast Tissue When It Is Medically Necessary

The U.S. Centers for Medicare and Medicaid Services has lifted its previous restriction on the use of ultrasound to help detect breast cancer in women who have dense breasts, so long as the procedure is medically necessary. The technology of ultrasound is applied in the technique of Doppler sonography. This non-invasive monitoring method measures ultrasound waves reflected back from moving objects in the body, such as blood cells and heart valves. Heart disease can be assessed by auscultation using a stethoscope and examining the movement of blood through blood vessels around the heart. The velocity of these movements can be calculated from their frequency or pitch using the Doppler effect. One common use of Doppler sonography is in assessing cerebral aneurysms, with high accuracy for detecting ruptured aneurysms. It is also used to measure peak systolic velocity (PSV), which has been shown to correlate well to cerebral artery.

What Are the Risks Associated With Dense Breast Tissue?

Dense breast tissue is not abnormal or unhealthy. However, it can make it more difficult to detect breast cancer on a mammogram. That’s because dense breast tissue appears white on a mammogram, while cancer appears as a dark mass. Additionally, dense breast tissue can also increase your risk of developing breast cancer. Studies have shown that women with dense breasts are up to five times more likely to develop breast cancer than women with less dense breasts. If you have dense breasts, it’s important to talk to your doctor about your risks and whether or not you should consider additional screening tests, such as an ultrasound or MRI.  Dense breast tissue is more common in younger women and decreases with age. It can make it harder to read mammograms and may be associated with a higher risk of developing cancer.

How Does Medicare Coverage of Ultrasound for Dense Breast Tissue Work?

Medicare will cover ultrasound for dense breast tissue when it is medically necessary. This means that your doctor has determined that the ultrasound is needed to diagnose or treat a medical condition. Medicare will not cover ultrasound for dense breast tissue if it is not medically necessary.

When will my health care provider be required to provide me with information about Medicare coverage of ultrasound for dense breast tissue? Your doctor must provide you with a copy of the CPT codebook and explain which codes he or she may use for your procedure. If your doctor orders the breast ultrasound, he or she must give you this notice: “IMPORTANT NOTICE ABOUT MEDICARE COVERAGE OF A BREAST ULTRASOUND SCREENING FOR DENSE BREAST TISSUE THROUGH THE MEDICARE ADVANTAGE PROGRAM OR MEDICARE PRESCRIPTION DRUG PLAN. Please contact your health plan to determine if this service is covered.” 

What Are the Alternatives to Ultrasound for Dense Breast Tissue?

There are several alternatives to ultrasound for dense breast tissue. One is magnetic resonance imaging (MRI). MRI uses magnetic waves to create images of the breast. Another option is mammography. Mammography uses low-dose x-rays to create images of the breast. A third option is breast tomosynthesis, also called 3D mammography. This technology uses x-rays to create three-dimensional images of the breast. The best option for each individual may vary depending on factors such as age, breast density, and family history. According to Sara Routhier, Director of Outreach at, some other potential options include: 

  • tomosynthesis (3D mammography)
  • molecular breast imaging (MBI)
  • Breast MRI 
  • whole breast ultrasound 
  • handheld ultrasound 
  • Automated Whole Breast Ultrasound (AWBUS)
  • Contrast-enhanced spectral mammography (CESM)
  • Breast thermography

What Are the Limitations of This Coverage?

There are some limitations to this coverage. Medicare will only cover ultrasound for dense breast tissue when it is medically necessary. This means that if your doctor does not think that an ultrasound is the best way to diagnose or treat your condition, Medicare will not pay for it. Additionally, Medicare will only cover ultrasounds that are performed by a licensed healthcare provider.

In some cases, an ultrasound may help to determine whether a lump is benign or malignant. In other cases, an ultrasound may be used to guide the treatment of breast cancer and improve the success of treatment. A healthcare provider may also recommend an ultrasound if they think that it will provide information that cannot be obtained otherwise. For example, if you have a suspicious lump, your doctor might recommend that you get an ultrasound so that they can see what is underneath the skin or tissue around the lump in order to determine whether it is cancerous or not. 

The Truth About Medicare and Ultrasound

If you’re a patient with Medicare, you may have heard that Medicare covers ultrasound for dense breast tissue. But what does this really mean? First of all, it’s important to understand that dense breast tissue is not a medical condition. It’s simply a description of the way your breast tissue looks on a mammogram. Breast density is classified on a scale from 1 to 4, with 1 being the least dense and 4 being the most dense.

So, why does breast density matter? The answer has to do with how well a mammogram can detect cancer. Mammograms are designed to detect changes in the breast tissue that may be signs of cancer. But dense breast tissue can make it more difficult to spot those changes. That’s why women with dense breasts are often advised to have additional screenings, such as an ultrasound, to help ensure that any potential problems are found early. Fortunately, Medicare covers medically necessary ultrasounds for women with dense breasts. This means that if your doctor orders an ultrasound because they feel it is necessary for your care, Medicare will help pay for it.


Medicare covers ultrasound for dense breast tissue when it is medically necessary. If you have Medicare and have been diagnosed with dense breast tissue, you may be eligible for coverage of an ultrasound. Be sure to speak with your doctor to see if this option is right for you.

John Norwood
John Norwood is best known as a technology journalist, currently at Ziddu where he focuses on tech startups, companies, and products.