Medicare covers DEXA scans under Part B when your doctor orders one for a medical reason, but coverage depends on your age, sex, and risk factors for osteoporosis.

A DEXA scan (dual-energy X-ray absorptiometry) measures bone density and helps doctors detect osteoporosis or assess fracture risk. Medicare Part B pays for the scan itself — typically 80 percent of the approved amount after you meet your annual deductible — and you pay the remaining 20 percent. The scan usually costs between $100 and $300 out of pocket, though the exact amount depends on where you have it done and your specific plan.

The key to coverage is medical necessity. Medicare will not pay for a DEXA scan straightforward because you want one or are worried about bone health. Your doctor must order it based on specific criteria that Medicare recognizes as medically appropriate.

Key Takeaways

  • Medicare Part B covers DEXA scans when ordered by a doctor for medical reasons, and you pay 20 percent of the approved cost after meeting your deductible.
  • Women age 65 and older, and men age 70 and older, can have a DEXA scan covered once every two years without additional risk factors.
  • Younger people may may have access to if they have specific risk factors such as long-term steroid use, rheumatoid arthritis, or a personal history of fractures.
  • Your doctor must document the medical reason for the scan in your chart; Medicare reviews claims that appear medically unnecessary and may deny payment.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower, depending on your plan's coverage rules.

Who qualifies for covered DEXA scans under Medicare

Medicare has specific age and risk-based rules for DEXA coverage. Women age 65 and older can have a DEXA scan covered once every two years. Men age 70 and older may have access to under the same frequency. If you are younger than these ages, you can still have a covered scan if you meet certain risk criteria.

Risk factors that make you may be able to access for a DEXA scan at a younger age include long-term use of corticosteroids (such as prednisone), a diagnosis of rheumatoid arthritis, a personal history of osteoporosis or a fragility fracture, or a family history of osteoporosis. Your doctor must document which risk factor applies to you and include that in the order.

Medicare also covers DEXA scans for people who are taking or planning to take osteoporosis medication, to establish a baseline bone density before starting treatment or to monitor response to therapy.

How to get a DEXA scan covered by Medicare

Start by talking to your primary care doctor or a specialist such as a rheumatologist or endocrinologist. Tell them about any bone health concerns, fractures, or risk factors you have. Your doctor will decide whether a DEXA scan is medically necessary based on your age, health history, and symptoms.

If your doctor orders the scan, they will send the order to an imaging center or hospital that accepts Medicare. When you call to schedule, tell the facility that you have Medicare and that your doctor has ordered the scan. Ask them to confirm that the facility is Medicare-approved and that they will bill Medicare directly.

Bring your Medicare card and any other insurance cards to your appointment. The facility will handle billing to Medicare. After Medicare processes the claim, you will receive an explanation of benefits (EOB) in the mail, which shows what Medicare paid and what you owe.

What happens if Medicare denies the claim

If Medicare denies your DEXA scan claim, you will receive a notice explaining the reason. The most common reason for denial is that the scan was not medically necessary according to Medicare's criteria — for example, if you are a 55-year-old woman with no risk factors and no symptoms, Medicare may not cover it.

You have the right to appeal a denial. You can ask your doctor to provide additional documentation about why the scan was medically necessary, and you can submit that with a written appeal to Medicare. The appeal process has several levels, and you can request a review by a Medicare contractor or, later, by an independent reviewer.

If you believe the denial is incorrect, contact your doctor's office and ask them to help you file an appeal. Many imaging centers also have staff who handle Medicare appeals and can guide you through the process.

DEXA scans and Medicare Advantage plans

If you have a Medicare Advantage plan (Part C), your coverage for DEXA scans is the same as Original Medicare — the plan must cover medically necessary scans — but your out-of-pocket cost may differ. Some Medicare Advantage plans charge a copay for imaging services instead of the 20 percent coinsurance you would pay under Original Medicare.

Before scheduling a DEXA scan, call your Medicare Advantage plan and ask what you will owe. Some plans require prior authorization, meaning your doctor must get approval from the plan before the scan is done. If your doctor orders a scan without prior authorization and the plan denies it, you could be responsible for the full cost.

Check your plan's summary of benefits or call the plan's customer service number to find out whether prior authorization is required and what your copay or coinsurance will be.

Medigap coverage for DEXA scans

If you have a Medigap policy, it may help pay your share of the DEXA scan cost. Most Medigap plans cover the 20 percent coinsurance that you would owe under Original Medicare after the plan pays its share. The exact coverage depends on which Medigap plan (A through N) you have.

Plans C, D, F, G, M, and N typically cover coinsurance for Part B services, which includes DEXA scans. Plans A, B, K, and L have more limited coverage. Check your Medigap policy documents or call your insurance company to confirm what your plan covers for imaging services.

Frequently Asked Questions

Can I get a DEXA scan covered if I have never had a fracture?

Yes. You do not need a fracture history to may have access to. Women age 65 and older, and men age 70 and older, can have a covered DEXA scan based on age alone. Younger people can may have access to if they have risk factors such as steroid use, rheumatoid arthritis, or a family history of osteoporosis.

How often does Medicare cover DEXA scans?

Medicare covers one DEXA scan every two years for people who meet age or risk criteria. If you are being treated for osteoporosis, your doctor may order more frequent scans to monitor your response to medication, and Medicare may cover those if they are medically necessary.

What if I want a DEXA scan but my doctor says it is not medically necessary?

You can pay out of pocket for a scan that Medicare will not cover. The cost is usually $100 to $300. If you believe the scan is medically necessary and your doctor disagrees, you can ask for a second opinion from another doctor, such as a rheumatologist or bone specialist.

Will I owe anything if Medicare covers my DEXA scan?

Yes, you will owe 20 percent of the Medicare-approved amount after you meet your Part B deductible for the year. If you have Medigap or a Medicare Advantage plan with low copays, your out-of-pocket cost may be much lower. Call your plan before the scan to find out exactly what you will owe.

Does my doctor need to get approval from Medicare before ordering a DEXA scan?

No, your doctor does not need prior authorization from Medicare to order a DEXA scan. However, if you have a Medicare Advantage plan, your plan may require prior authorization. Check with your plan before scheduling.