Is a DEXA Scan Covered by Medicare?
Navigate Medicare coverage for DEXA scans. Learn when your bone density test is covered, associated costs, and steps to ensure eligibility.
A Dual-energy X-ray absorptiometry, or DEXA scan, is an imaging test that uses X-rays to measure bone mineral density. Healthcare providers use DEXA scans to screen for osteoporosis and osteopenia, conditions that weaken bones. These scans help assess fracture risk and guide treatment strategies.
When Medicare Covers DEXA Scans
Medicare covers DEXA scans under specific medical conditions to manage bone health. Medicare Part B generally covers bone mass measurements once every 24 months if a beneficiary meets certain eligibility criteria. Medicare may cover scans more often if medically necessary, such as for women aged 65 and older, and men aged 70 and older, for routine bone density testing.
This includes women who are estrogen deficient and at clinical risk for osteoporosis. Coverage also extends to individuals with vertebral abnormalities detected by X-ray, indicative of osteoporosis, osteopenia, or vertebral fracture. People receiving or expecting long-term glucocorticoid (steroid) therapy (average of 5.0 mg prednisone or greater per day for over three months) also qualify. Those diagnosed with primary hyperparathyroidism are eligible. DEXA scans are also covered for individuals monitored for response to an approved osteoporosis drug therapy.
Medicare Parts Involved and Cost Sharing
DEXA scans are covered under Medicare Part B, which covers medically necessary outpatient services. For 2025, the annual deductible for Medicare Part B is $257. After meeting this deductible, beneficiaries typically pay a 20% coinsurance of the Medicare-approved amount for most Part B services, with Medicare paying the remaining 80%.
A Medicare Supplement (Medigap) plan may cover some or all of the Part B deductible and coinsurance, reducing out-of-pocket expenses. Medicare Advantage (Part C) plans, offered by private companies, must cover the same benefits as Original Medicare Part A and Part B. These plans may have different cost-sharing structures, such as copayments, and can cover a portion of the Part B deductible and coinsurance.
Steps for Ensuring Coverage
To ensure Medicare covers a DEXA scan, beneficiaries should take several steps. First, obtain a physician’s order for the scan, as Medicare requires the test to be medically necessary and ordered by a qualified healthcare provider.
The ordering physician must document the medical necessity in the patient’s medical record, aligning with Medicare’s qualifying conditions (e.g., estrogen deficiency, vertebral abnormalities, specific drug therapies, hyperparathyroidism). Without proper documentation, coverage may be denied.
Confirm that both the ordering physician and the facility accept Medicare assignment. Providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment.
Check with the scan facility or, if enrolled in a Medicare Advantage plan, with the plan directly, regarding any prior authorization requirements before the scan. After the scan, review the Explanation of Benefits (EOB) from Medicare to understand claim processing and financial responsibility.