Medicare Coverage for DEXA Scans: What You'll Pay

Medicare Part B covers DEXA scans when your doctor orders one to check for osteoporosis, but you pay a share of the cost after you meet your deductible.

A DEXA scan (dual-energy X-ray absorptiometry) measures bone density and screens for osteoporosis. Medicare Part B treats it as a diagnostic test, which means it follows the standard cost-sharing rules: you pay 20% of the approved amount after your annual Part B deductible ($240 in 2024, though this changes yearly). The provider bills Medicare first, and Medicare pays 80% of what it considers the reasonable charge.

The actual amount you owe depends on where you have the scan done and what your Medigap or Medicare Advantage plan covers. If you have a Medigap policy, it may cover some or all of your 20% coinsurance. If you have a Medicare Advantage plan, your out-of-pocket cost is set by that plan and may be lower or higher than the standard 20%.

Key Takeaways

Medicare Part B covers DEXA scans ordered by your doctor to screen for or monitor osteoporosis.
You pay 20% of the Medicare-approved amount after you meet your annual Part B deductible, unless you have supplemental coverage.
Medicare covers one DEXA scan every 24 months for most beneficiaries, or more often if medically necessary.
The scan must be ordered by a physician; you cannot request one on your own and have Medicare pay for it.

When Medicare Covers a DEXA Scan

Medicare Part B covers a DEXA scan if a doctor orders it for one of these reasons: to screen for osteoporosis in women age 65 and older, to screen for osteoporosis in men age 70 and older, to monitor bone density in people already diagnosed with osteoporosis, or to check for bone loss in people taking certain medications (such as corticosteroids) that weaken bone.

Your doctor must document medical necessity in your chart. straightforward asking for a bone density check because you are worried about osteoporosis is not enough — your doctor has to have a clinical reason to order it. If you have a personal or family history of osteoporosis, fractures, or conditions that affect bone health, mention this to your doctor so they can decide whether a scan is warranted.

Medicare also covers repeat scans, but with limits. For most people, Medicare covers one DEXA scan every 24 months. If you have a diagnosis of osteoporosis or are being treated for bone loss, your doctor may order scans more frequently, and Medicare will cover them if the medical reason is documented.

What You Pay Out of Pocket

Your out-of-pocket cost has two parts: your Part B deductible and your coinsurance. The Part B deductible is $240 per year (as of 2024), and you pay this once per calendar year before Medicare starts paying its share. After you meet the deductible, Medicare pays 80% of the approved amount for the DEXA scan, and you pay 20%.

The actual dollar amount of your 20% depends on what Medicare approves for the scan in your area. This varies by location and facility. A DEXA scan at a hospital outpatient department may have a different approved amount than the same scan at a standalone imaging center. Call the facility where you plan to have the scan and ask what the Medicare-approved charge is, then calculate 20% of that figure to estimate your cost.

If you have already met your Part B deductible earlier in the year (for example, because you had other medical services), you will owe only the 20% coinsurance for the DEXA scan with no additional deductible.

How Supplemental Insurance Affects Your Cost

If you have a Medigap policy (also called supplemental insurance), it may cover part or all of your 20% coinsurance. The amount depends on which Medigap plan you have. Plans C, D, G, M, and N all cover some portion of coinsurance for Part B services. Plan G, for example, covers 80% of your coinsurance after you meet the Part B deductible, meaning you would owe only 4% of the approved amount instead of 20%.

If you have a Medicare Advantage plan, you do not have the standard 20% coinsurance. Instead, your plan sets its own cost-sharing rules. You might owe a flat copay (for example, $50 for a diagnostic imaging service), a percentage of the cost, or nothing at all, depending on your plan. Check your plan's summary of benefits or call the plan to find out what you will owe for a DEXA scan.

If you have neither Medigap nor Medicare Advantage and are on Original Medicare alone, you are responsible for the full 20% coinsurance after your deductible.

How to Get a DEXA Scan Covered

Start by talking to your primary care doctor or your bone health specialist. Describe any symptoms, risk factors, or concerns you have about bone density. Your doctor will decide whether a DEXA scan is medically necessary based on your age, health history, and current medications.

If your doctor agrees to order one, ask them which imaging center or hospital they recommend. Some facilities are in-network with Medicare Advantage plans, which may affect your cost. Your doctor's office will send the order to the imaging facility, and the facility will schedule you.

Before your appointment, call the imaging center and confirm that they accept Medicare and that the scan is covered under your plan. Ask about the out-of-pocket cost so you are not surprised at the time of service. Bring your Medicare card and any other insurance cards (Medigap or Medicare Advantage) with you to the appointment.

What Happens if Medicare Denies the Scan

If Medicare denies coverage for your DEXA scan, it usually means the medical documentation did not meet Medicare's criteria, or the scan was ordered too soon after a previous one (within 24 months). The imaging facility will send you a notice explaining the denial and your right to appeal.

You can ask your doctor to submit additional medical information to support the medical necessity of the scan. If your doctor believes the scan was medically necessary, they can file an appeal on your behalf. You can also file an appeal yourself by following the instructions on the denial notice.

If you disagree with a denial and believe the scan should have been covered, you have the right to request a reconsideration from Medicare. The process takes time, so ask the imaging center whether they will hold your bill while the appeal is pending.

DEXA Scans at Different Facilities

DEXA scans are performed at hospitals, outpatient imaging centers, bone health clinics, and some doctor's offices. Medicare covers the scan regardless of where it is done, as long as the facility is Medicare-certified and your doctor orders it for a covered reason.

The cost to you may differ depending on the facility type. Hospital outpatient departments often have higher Medicare-approved charges than standalone imaging centers, which means your 20% coinsurance will be higher. If cost is a concern, ask your doctor whether the scan can be done at an outpatient imaging center instead of a hospital.

If you have a Medicare Advantage plan, check whether the facility is in-network. Using an out-of-network facility may result in higher out-of-pocket costs or may not be covered at all, depending on your plan's rules.

Frequently Asked Questions

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

You do not need a formal referral, but your doctor must order the scan. Medicare will not cover a DEXA scan that you request on your own or that is ordered by a nurse or technician without a physician's order. Your doctor's order must document a medical reason for the scan.

Will Medicare cover a DEXA scan if I am under 65?

Yes, if your doctor orders it for a covered reason. Medicare does not have an age limit for DEXA scans; it covers them based on medical necessity. If you are under 65 and have Medicare (for example, due to disability), a DEXA scan can be covered if your doctor documents that it is medically necessary.

How often can I have a DEXA scan and still have Medicare pay for it?

Medicare covers one DEXA scan every 24 months for routine screening. If you have osteoporosis or are being treated for bone loss, your doctor may order scans more frequently, and Medicare will cover them if the medical reason is documented in your chart. Ask your doctor how often you need monitoring based on your diagnosis.

What if I had a DEXA scan before I turned 65 and enrolled in Medicare?

Medicare does not cover scans performed before you were enrolled in Medicare. However, if you need another scan after you enroll, Medicare will cover it based on the 24-month rule from the date of your previous scan, regardless of whether Medicare paid for that earlier scan.

Can I get a DEXA scan at my doctor's office, or does it have to be at an imaging center?

Some doctor's offices have DEXA equipment and can perform the scan on-site. Medicare covers it in either location, as long as the facility is Medicare-certified and your doctor orders it for a covered reason. Ask your doctor's office whether they offer DEXA scans or whether you need to go to a separate imaging center.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.