How Often Does Medicare Cover a DEXA Scan?
Demystify Medicare coverage for DEXA scans. Learn eligibility, frequency, costs, and steps to get your bone density scan covered.
A Dual-energy X-ray Absorptiometry (DEXA) scan is a specialized imaging test measuring bone mineral density. This non-invasive procedure assesses bone strength and thickness, helping diagnose conditions like osteopenia and osteoporosis. By evaluating bone mineral content, particularly in the spine and hip, DEXA scans can predict future fracture risk and monitor osteoporosis treatment effectiveness. Medicare covers DEXA scans when specific criteria are met.
Medicare Coverage Criteria
Medicare Part B covers DEXA scans for bone density testing under specific medical conditions. Coverage is provided once every two years for eligible beneficiaries. More frequent scans may be covered if medically necessary.
Individuals qualify for coverage if they have certain risk factors or existing conditions. These include women determined by a physician to be estrogen-deficient and at clinical risk for osteoporosis. Coverage also extends to individuals with X-ray evidence of osteoporosis, osteopenia, or vertebral fractures. Those receiving or expected to receive glucocorticoid (steroid) therapy for more than three months may also be eligible. Individuals diagnosed with primary hyperparathyroidism or those being monitored to assess their response to FDA-approved osteoporosis drug therapy are covered.
Understanding Your Costs
DEXA scans, when covered by Medicare, fall under Medicare Part B. Beneficiaries are responsible for out-of-pocket costs. After the annual Part B deductible is met, individuals pay 20% of the Medicare-approved amount for the scan.
For 2025, the standard Medicare Part B deductible is $257. Once this deductible is satisfied, Medicare pays 80% of the approved charge, and the beneficiary pays the remaining 20% coinsurance. If a beneficiary has supplemental insurance, such as a Medigap policy or a Medicare Advantage Plan, these plans may cover some or all of the Part B deductible and coinsurance, potentially reducing out-of-pocket expenses.
Steps to Get a Covered Scan
Obtaining a Medicare-covered DEXA scan requires a physician’s order, confirming medical necessity. The doctor must determine the scan aligns with Medicare’s established coverage criteria. This ensures the test is for diagnostic or monitoring purposes related to bone health, not body composition analysis.
Beneficiaries should confirm the facility performing the DEXA scan accepts Medicare assignment. Facilities accepting assignment agree to Medicare’s approved payment as full payment, limiting the amount they can bill the patient. When scheduling, bringing your Medicare card and the physician’s order will facilitate the process.