Medicare Part B covers bone density scans under specific conditions

Medicare Part B will pay for a bone density scan (also called a DXA scan or DEXA scan) if your doctor orders it and you meet certain medical criteria. The scan measures bone thickness and helps detect osteoporosis or the risk of fractures. Medicare does not cover the scan straightforward because you want one — your doctor must document a medical reason, and you must fit into one of the covered categories.

The scan itself is typically done at a hospital, imaging center, or doctor's office. Medicare pays 80 percent of the approved amount after you meet your Part B deductible for the year. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers additional costs.

Key Takeaways

  • Medicare Part B covers bone density scans when ordered by your doctor for medical reasons, not for routine screening alone.
  • You must fall into one of Medicare's covered categories, such as being a woman over 65, a man over 70, or having a condition that weakens bone.
  • Medicare pays 80 percent of the approved amount; you pay 20 percent after meeting your Part B deductible.
  • Your doctor must order the scan and document the medical reason in your medical record for Medicare to pay.
  • Frequency limits explore — Medicare typically covers one scan every two years, or more often if medically necessary.

Who qualifies for a covered bone density scan

Medicare covers bone density scans for women age 65 and older, and for men age 70 and older, even without symptoms or known bone loss. This is considered screening for people at higher risk of osteoporosis based on age alone.

Medicare also covers scans for younger people (men under 70 and women under 65) if they have a medical condition or take a medication that weakens bone. Examples include rheumatoid arthritis, chronic kidney disease, hyperthyroidism, or long-term use of corticosteroids like prednisone. Your doctor must document the condition or medication in your medical record.

If you have already had a bone density scan that showed low bone mass or osteoporosis, Medicare will cover follow-up scans to monitor your bone density over time. The frequency depends on your results and your doctor's clinical judgment.

How often Medicare pays for repeat scans

Medicare typically covers one bone density scan every two years. If your first scan shows normal bone density, you may not need another scan for several years, depending on your age and risk factors.

If your scan shows low bone mass (osteopenia) or osteoporosis, your doctor may order a follow-up scan sooner to track changes. Medicare will pay for more frequent scans if your doctor documents that they are medically necessary — for example, if you are starting a new bone-strengthening medication and your doctor wants to measure the effect after one year.

Your doctor decides the timing based on your individual situation. Medicare's role is to pay for scans that meet the coverage rules; the decision about how often you need one is between you and your doctor.

What you pay out of pocket

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. The Part B deductible is set by Medicare each year and applies to most Part B services. Once you meet it, you pay 20 percent of Medicare's approved amount for the scan.

The approved amount varies by location and the type of facility where the scan is done. A hospital outpatient department may have a different approved amount than an independent imaging center. You can call the facility ahead of time and ask what the Medicare approved amount is, then calculate your 20 percent share.

If you have a Medigap plan (supplemental insurance), it may cover your 20 percent coinsurance. If you have a Medicare Advantage plan, your cost-sharing rules are different and depend on your specific plan — check your plan documents or call the plan to find out what you will owe.

How to arrange a covered bone density scan

Start by talking to your doctor. Tell them you are concerned about bone health or that you want to know your bone density status. Your doctor will decide whether a scan is medically appropriate for you based on your age, medical history, medications, and any symptoms you have.

If your doctor agrees, they will order the scan and send the order to an imaging facility. The facility will contact you to schedule an appointment. When you call to schedule, tell them you have Medicare and ask them to verify your coverage before the appointment. This gives you a chance to ask about your out-of-pocket cost and confirm that the facility is in-network (if you have a Medicare Advantage plan).

Bring your Medicare card to the appointment. The facility will bill Medicare directly. After Medicare processes the claim, you will receive a notice showing what Medicare paid and what you owe.

What happens if your doctor orders a scan that Medicare will not cover

If your doctor orders a bone density scan but you do not meet Medicare's coverage criteria, Medicare will deny the claim. This can happen if you are under 65 (or under 70 if you are male) and do not have a covered medical condition, or if you are having a scan too soon after your last one.

When Medicare denies a claim, the imaging facility must send you a notice called an Advance Beneficiary Notice (ABN) before the scan, telling you that Medicare may not pay and asking whether you want to proceed anyway. If you sign the ABN and go ahead with the scan, you are responsible for the full cost. If you do not sign it, the facility cannot bill you.

If you believe Medicare should have covered the scan, you can file an appeal. Your doctor's office can help you gather the medical documentation needed to support the appeal.

Bone density scans under Medicare Advantage plans

Medicare Advantage plans must cover bone density scans under the same medical criteria as Original Medicare. However, your out-of-pocket cost may be different. Some Advantage plans cover the scan with no coinsurance; others charge a copay or coinsurance.

Check your plan's formulary or call the plan's customer service line before scheduling the scan. Ask specifically whether the scan is covered, what your cost will be, and whether you need to use an in-network facility. Some Advantage plans require prior authorization, meaning your doctor must get approval from the plan before the scan is scheduled.

Frequently Asked Questions

Can I get a bone density scan just to check my bone health, even if I have no symptoms?

Yes, if you are a woman 65 or older or a man 70 or older. Medicare considers this screening and will cover it. If you are younger, Medicare will cover a scan only if you have a medical condition or take a medication that weakens bone, or if your doctor has documented a clinical reason to check your bone density.

Will Medicare pay for a bone density scan if I am under 65?

Medicare will cover a scan for someone under 65 only if they have a medical condition or take a medication known to weaken bone — such as rheumatoid arthritis, chronic kidney disease, or long-term corticosteroid use. Your doctor must document the reason in your medical record. Otherwise, you would pay the full cost yourself.

What if I had a bone density scan at my doctor's office instead of a hospital?

Medicare covers bone density scans done in a doctor's office, hospital outpatient department, or independent imaging center, as long as the facility is Medicare-enrolled and your doctor's order meets the coverage criteria. The approved amount and your out-of-pocket cost may differ depending on the type of facility, so ask ahead of time.

Do I need prior authorization from Medicare before scheduling a bone density scan?

Original Medicare does not require prior authorization for bone density scans that meet the coverage criteria. However, if you have a Medicare Advantage plan, your plan may require prior authorization. Check your plan documents or call the plan before scheduling.

Can I appeal if Medicare denies my bone density scan?

Yes. If Medicare denies the claim, you will receive a notice explaining why. You can file an appeal and include medical documentation from your doctor supporting the medical need for the scan. Your doctor's office can help you gather the records needed for the appeal.