Does Medicare Cover DEXA Scans for Bone Density?
Navigate Medicare's approach to bone density testing. Discover when DEXA scans are covered, what you'll pay, and how your plan affects access and costs.
Dual-energy X-ray absorptiometry, commonly known as a DEXA scan, is a specialized imaging test that measures bone mineral density. This non-invasive procedure assesses bone strength and thickness, helping healthcare providers diagnose conditions like osteopenia and osteoporosis. DEXA scans can help predict future fracture risk and monitor the effectiveness of osteoporosis treatments, particularly in areas such as the spine and hip. Medicare generally covers DEXA scans when specific criteria are met, making this diagnostic procedure accessible to eligible beneficiaries.
Medicare Part B Coverage Criteria
Medicare Part B primarily covers outpatient diagnostic services, including medically necessary DEXA scans for bone density testing. Coverage is provided once every 24 months for eligible beneficiaries. More frequent scans may be covered if deemed medically necessary by a healthcare provider.
Individuals qualify for coverage if they have certain risk factors or existing conditions. This includes women whose doctor determines they are estrogen-deficient and at a clinical risk for osteoporosis. Coverage also extends to individuals with X-ray evidence of osteoporosis, osteopenia, or vertebral fractures.
Additional qualifying conditions include receiving or expecting to receive glucocorticoid (steroid) therapy equivalent to 5.0mg of prednisone daily for over three months. Individuals diagnosed with primary hyperparathyroidism are also eligible for covered scans. Those being monitored to assess their response to an FDA-approved osteoporosis drug therapy may receive coverage.
Understanding Your Costs
When a DEXA scan is covered by Medicare Part B, beneficiaries are responsible for certain out-of-pocket costs. The standard Medicare Part B deductible must first be met before Medicare begins to pay its share. For 2025, the annual deductible for all Medicare Part B beneficiaries is $257.
After the deductible is satisfied, individuals pay 20% of the Medicare-approved amount for the scan. Medicare then covers the remaining 80% of the approved charge. This 20% portion is known as coinsurance.
It is important to use providers who accept Medicare assignment. When a provider accepts Medicare assignment, they agree to accept the Medicare-approved amount as full payment for the service. This means they cannot bill you for more than the deductible and coinsurance amounts.
Navigating the Coverage Process
You must secure an order or referral from a qualified healthcare provider. This order confirms the medical necessity of the scan, indicating it aligns with Medicare’s established coverage criteria for diagnostic or monitoring purposes related to bone health.
You should also confirm that your healthcare provider is enrolled in Medicare. Verify that the facility where the DEXA scan will be performed also accepts Medicare. Facilities that accept Medicare assignment agree to the Medicare-approved payment as full payment, which can help limit your out-of-pocket expenses.
Some procedures may require pre-authorization. It is advisable to confirm any specific requirements with your doctor’s office or the imaging center beforehand. Taking these steps helps ensure your scan is processed correctly under your Medicare benefits.
Medicare Advantage Plans and DEXA Scans
For individuals enrolled in a Medicare Advantage Plan, DEXA scan coverage is available. Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, including medically necessary DEXA scans.
These private plans may have different rules regarding how you access services. This can include specific network providers that you must use or requirements for referrals before receiving a scan. Your out-of-pocket costs, such as copays or coinsurance, may also vary from what you would pay under Original Medicare.
Beneficiaries with Medicare Advantage plans should contact their specific plan directly. This allows you to understand your benefits, confirm network requirements, and clarify any cost-sharing responsibilities for DEXA scans. Understanding these details ensures you can access necessary bone density testing within your plan’s guidelines.