How Often Does Medicare Pay for a DEXA Scan?

DEXA (Dual-energy X-ray Absorptiometry) scans are a diagnostic tool used to assess bone health. They help detect conditions like osteoporosis, which causes bones to become brittle and prone to fractures. Medicare provides coverage for DEXA scans, recognizing their value in preventive care and disease management, ensuring beneficiaries can access essential screenings.

Medicare’s Coverage for DEXA Scans

A DEXA scan is an imaging test that measures bone mineral density, focusing on areas like the hip and spine. It uses a low dose of X-rays to determine the amount of calcium and other minerals in your bones. The scan’s purpose is to diagnose osteoporosis, assess fracture risk, and monitor osteoporosis treatment effectiveness. Early identification of bone density changes allows healthcare providers to prevent serious bone-related issues.

Medicare Part B covers outpatient medical services, generally including DEXA scans when medically necessary. A physician must order the scan to diagnose or monitor a condition, or as a preventive measure for at-risk individuals. While Medicare Part A may cover a DEXA scan during an inpatient hospital stay, Part B is the primary coverage for these outpatient tests. For coverage, the facility performing the scan must accept Medicare assignment.

Determining DEXA Scan Frequency with Medicare

Medicare’s standard coverage for a DEXA scan is once every 24 months for preventive screening. This frequency applies if you meet certain eligibility criteria, such as being a woman determined by your doctor to be estrogen-deficient and at clinical risk for osteoporosis. However, specific medical conditions or risk factors can qualify an individual for more frequent scans. If your X-rays show signs of osteoporosis, osteopenia, or vertebral fractures, more frequent testing may be covered.

Additional medical circumstances for more frequent DEXA scans include receiving long-term glucocorticoid (steroid) therapy for over three months, or being diagnosed with primary hyperparathyroidism. Coverage may also apply if you are being monitored for response to an FDA-approved osteoporosis drug therapy. In all cases, a physician’s order and documented medical necessity are required for coverage, regardless of the frequency.

Understanding Your Out-of-Pocket Costs for DEXA Scans

When Medicare Part B covers a DEXA scan, you generally have out-of-pocket costs. After meeting the annual Part B deductible, Medicare typically pays 80% of the approved amount. You are responsible for the remaining 20% coinsurance. For example, if the approved amount is $100, you would pay $20 after your deductible is met.

If a DEXA scan is performed as a “preventive service” for certain high-risk individuals and the facility accepts Medicare assignment, Medicare may cover 100% of the cost. This means you would not pay any coinsurance or have the scan apply towards your deductible. It is advisable to confirm coverage details and potential costs with your physician and the Medicare provider before the scan, as individual circumstances and plan details can affect your financial responsibility.