Medicare Part B covers DEXA scans when your doctor orders one to check for osteoporosis or monitor bone loss, but only if you meet specific medical criteria.

A DEXA scan (dual-energy X-ray absorptiometry) is an imaging test that measures bone density. Medicare Part B pays for the scan itself at 80 percent of the approved amount after you meet your annual deductible, and you pay the remaining 20 percent as coinsurance. The test is typically performed at a hospital outpatient department or imaging center.

The key to coverage is medical necessity. Your doctor must order the scan for a reason Medicare recognizes — most commonly to diagnose osteoporosis, assess fracture risk, or monitor the effectiveness of osteoporosis treatment you are already taking. A routine screening without symptoms or risk factors may not be covered.

Key Takeaways

  • Medicare Part B covers DEXA scans at 80 percent of the approved amount when medically necessary, after you meet your deductible.
  • Your doctor must order the scan for a recognized medical reason, such as diagnosing osteoporosis or monitoring treatment.
  • Medicare covers screening DEXA scans for women age 65 and older and men age 70 and older without requiring symptoms first.
  • You pay 20 percent coinsurance for the scan itself, plus any facility fees charged by the imaging center.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower depending on your plan's coverage.

Who qualifies for Medicare coverage of DEXA scans

Medicare covers screening DEXA scans for women age 65 and older and men age 70 and older, even if you have no symptoms or known bone loss. This is considered preventive care under Medicare Part B. Your doctor does not need to document a specific reason — age alone qualifies you for one scan every two years.

Medicare also covers DEXA scans for younger adults (men under 70 and women under 65) if your doctor documents a medical reason. Common reasons include a prior fracture from minor trauma, long-term use of corticosteroid medications, rheumatoid arthritis, or other conditions that increase fracture risk. Your doctor must note the reason in your medical record before the scan is ordered.

If you are already being treated for osteoporosis with medication, Medicare covers repeat DEXA scans to monitor whether the treatment is working. The frequency depends on your individual situation and what your doctor orders.

What you pay out of pocket

Your costs depend on whether you have Original Medicare alone or a supplemental plan. With Original Medicare Part B, you pay your annual deductible (which changes each year) plus 20 percent coinsurance for the scan itself. The imaging center may also charge a facility fee, which is separate from the scan charge.

If you have a Medigap policy, your supplemental plan may cover some or all of the 20 percent coinsurance, depending on which plan you hold. Plans C, D, G, and M typically cover coinsurance; Plans A and B do not. Check your plan documents or call your Medigap insurer to confirm.

If you have a Medicare Advantage plan, your out-of-pocket costs vary by plan. Some plans cover DEXA scans with no coinsurance; others charge a copay. Review your plan's coverage details or call the plan's customer service number on your insurance card.

How to arrange a DEXA scan through Medicare

Start by talking to your primary care doctor or the doctor treating your bone health. Explain any symptoms (such as back pain or loss of height), mention any fractures you have had, and ask whether a DEXA scan would be useful for you. Your doctor will decide whether the scan is medically necessary and will place the order.

Your doctor's office will typically send the order to an imaging center — often a hospital outpatient department, a standalone imaging clinic, or a radiology practice. The imaging center will contact you to schedule the appointment. When you call to schedule, confirm that the facility accepts Medicare and ask about any out-of-pocket costs you may owe.

Bring your Medicare card and any other insurance cards to the appointment. The scan itself takes about 10 to 30 minutes and involves lying still on a table while a scanner passes over your body. There is no pain, no injection, and no recovery time.

What happens if Medicare denies coverage

If the imaging center or Medicare denies your claim, you will receive a notice explaining the reason. Common reasons for denial include the scan being ordered without a documented medical reason, the scan being performed too soon after a previous one, or the facility not being Medicare-approved.

You have the right to appeal a denial. The notice you receive will explain how to file an appeal and the important date for doing so — usually 120 days from the date of the notice. You can ask your doctor's office to help you gather documentation showing why the scan was medically necessary.

If you disagree with a denial and believe the scan should have been covered, you can also contact your State Health Insurance information Program (SHIP). SHIP offers free counseling about Medicare coverage decisions and can help you understand your appeal options. Find your state's SHIP by visiting the Eldercare Locator at 1-800-677-1116.

DEXA scans versus other bone density tests

DEXA is the standard test Medicare covers for measuring bone density. Other imaging methods exist — such as quantitative ultrasound or CT scans — but Medicare does not routinely cover them for bone density screening. Your doctor may order one of these alternatives if you cannot have a DEXA scan for medical reasons (for example, if you are pregnant or cannot lie still), but you should confirm with Medicare or your plan before the test whether it will be covered.

If your doctor recommends an alternative test and you are unsure whether Medicare will cover it, ask your doctor to contact your Medicare plan or call Medicare directly at 1-800-MEDICARE (1-800-633-4227) before the test is performed. This can prevent an unexpected bill.

Frequently Asked Questions

How often can I have a DEXA scan covered by Medicare?

Medicare covers one DEXA scan every two years for screening purposes if you are age 65 or older (women) or age 70 or older (men). If you are being treated for osteoporosis, your doctor may order scans more frequently to monitor treatment, and Medicare may cover these if medically necessary. Your doctor decides the appropriate frequency based on your individual situation.

Do I need a referral from my primary care doctor to get a DEXA scan?

You do not need a formal referral, but your doctor does need to order the scan. Any doctor you see — your primary care doctor, a rheumatologist, an endocrinologist, or an orthopedist — can place the order if they believe the scan is medically necessary. The imaging center will receive the order directly from the doctor's office.

What if I have both Medicare and Medicaid?

If you have both Medicare and Medicaid (called "dual may be able to access"), Medicare is your primary payer. Medicare covers the DEXA scan first, and Medicaid may cover some or all of your remaining out-of-pocket costs, depending on your state's Medicaid rules. Contact your state Medicaid office or your Medicaid managed care plan to learn what they cover.

Will Medicare cover a DEXA scan if I have no symptoms?

Yes. If you are a woman age 65 or older or a man age 70 or older, Medicare covers one screening DEXA scan every two years with no symptoms required. For younger adults, Medicare covers a scan only if your doctor documents a medical reason, such as a prior fracture, medication use, or a condition that increases fracture risk.

Can I get a DEXA scan at my local hospital, or does it have to be at a specific imaging center?

You can have the scan at any Medicare-approved imaging facility, including hospital outpatient departments, standalone imaging centers, and radiology clinics. When you schedule, confirm that the facility accepts Medicare. If you use a non-Medicare-approved facility, you may be responsible for the full cost of the scan.