Medicare_Carriers_Manual / 5266 / 5266

Why This Topic Matters

Screening mammography is a high-volume preventive service with payment provisions that can affect claim submission, reimbursement calculation, and beneficiary liability. Understanding the manual’s scope helps billing and compliance staff recognize how Medicare structures payment for this service over time and across provider situations.

Article Sections

1. 5266. Payment for Screening Mammography

   Introduces the Medicare payment policy for screening mammography and distinguishes it from diagnostic mammography. It also identifies the effective date of the guidance.

2. A. Coding and Relative Value Units

   Discusses the billing code reference for screening mammography and notes related relative value unit information tied to radiologist services.

3. B. Payment Levels

   Outlines the general payment framework for screening mammography, including the major payment components and annual update concepts. It also addresses limitations for certain settings of care.

4. C. Services of New Physicians

   Addresses how payment reductions are applied to screening mammography services furnished by new physicians.

5. D. Special Rules for Services of Nonparticipating Physicians and Suppliers

   Summarizes special payment and charge-limit provisions that apply when services are furnished by nonparticipating physicians and suppliers. It includes time-based rules tied to calendar years and later effective dates.