Medicare covers bone density tests at no cost to you when your doctor orders one for screening

Medicare Part B pays for a bone density test (also called a DXA scan or DEXA scan) with no copay or deductible when it meets Medicare's coverage rules. You do not pay anything out of pocket if your test is covered. The catch is that Medicare only pays for the test under specific circumstances — not just because you want one or because you are worried about your bones.

The test itself is quick, painless, and uses low-dose X-rays to measure how dense your bones are. It takes about 10 to 30 minutes. Your doctor orders it, you go to an imaging center or hospital, and Medicare sends payment directly to the facility.

Key Takeaways

  • Medicare Part B covers one bone density test every 24 months at no cost when your doctor orders it for a covered reason.
  • You must meet one of Medicare's specific criteria — such as being a woman age 65 or older, a man age 70 or older, or having risk factors for bone loss — for the test to be covered.
  • If you pay out of pocket for a test that does not meet Medicare's rules, you cannot bill Medicare later.
  • Your doctor's office can tell you before the test whether Medicare will cover it based on your age and medical history.

Who Medicare covers for bone density screening

Medicare covers bone density tests for women age 65 and older and men age 70 and older, even if they have no symptoms or known risk factors. If you are younger than those ages, Medicare may still cover the test if you have certain risk factors for bone loss.

Risk factors that make you covered include a personal history of fracture as an adult, a family history of osteoporosis or fracture, use of corticosteroid medications for three months or longer, or certain medical conditions that affect bone density (such as rheumatoid arthritis, chronic kidney disease, or hyperthyroidism). Your doctor determines whether your situation meets one of these criteria.

Medicare also covers the test if you are a woman who stopped taking hormone replacement therapy, since that can increase bone loss risk. The test must be ordered by your doctor — you cannot order it yourself and have Medicare pay.

How often Medicare pays for the test

Medicare covers one bone density test every 24 months. If you had a covered test in January, Medicare will not pay for another one until January of the following year at the earliest. Some people need more frequent testing if they are on certain medications or have specific conditions, but Medicare's standard coverage is once every two years.

If your doctor believes you need testing more often than every 24 months, your doctor can request an exception from Medicare. This is not automatic, and Medicare will review the medical reason before deciding. Your doctor's office handles this request.

What happens if the test is not covered

If your test does not meet Medicare's coverage rules, you will receive a notice before or after the test explaining why. You are responsible for the full cost if you choose to go ahead. The facility must tell you in advance that Medicare will not pay — this is called an Advanced Beneficiary Notice (ABN).

If you sign an ABN, you are agreeing to pay out of pocket. Do not sign it unless you understand the cost and agree to pay. If you do not sign and Medicare denies the claim, the facility cannot bill you — they must absorb the cost. Always ask your doctor's office or the imaging center whether the test will be covered before you have it done.

How to learn about your test will be covered

Call your doctor's office and ask whether a bone density test would be covered by Medicare in your situation. Your doctor knows your age, medical history, and medications, so they can tell you whether you meet Medicare's rules. If you are unsure, ask the office to check with Medicare before you schedule the test.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and describe your situation. Medicare staff can tell you whether the test is covered based on your age and the reason your doctor wants it. Have your Medicare card handy when you call.

When you schedule the test at the imaging center or hospital, confirm with them that they have received the order from your doctor and that they have verified coverage with Medicare. This takes a few minutes and prevents surprises later.

What the test costs if you pay out of pocket

If Medicare does not cover the test, the cost varies widely depending on where you have it done. A bone density test at a hospital can cost $200 to $500 or more. The same test at an independent imaging center may cost $100 to $300. Some community health centers offer it for less.

If you are uninsured or underinsured and need a bone density test, ask your doctor whether a community health center or hospital financial information program can help. Some facilities offer sliding-scale fees based on income. Your doctor's office may also know of low-cost screening programs in your area.

What happens after the test

The imaging center sends the results to your doctor within a few days. Your doctor reviews the results and calls you to discuss what they mean. The results show your bone density compared to healthy young adults and tell your doctor whether you have normal bone density, low bone density (osteopenia), or osteoporosis.

If the results show bone loss, your doctor may recommend treatment, lifestyle changes, or follow-up testing. Medicare covers certain osteoporosis medications if your doctor prescribes them. Your doctor will explain next steps based on your individual results.

Frequently Asked Questions

Do I need a referral from my primary care doctor to get a bone density test?

No, but your doctor must order the test for Medicare to pay. You can see any doctor — your primary care doctor, a rheumatologist, an endocrinologist, or an orthopedist — and ask them to order it. The doctor decides whether the test is medically necessary based on your situation.

Will Medicare pay if I had a bone density test at a private clinic last year?

Medicare's 24-month clock starts from whenever your last covered test was, regardless of where you had it. If you had a covered test through Medicare last year, Medicare will not pay for another one until 24 months have passed. If you paid out of pocket at a private clinic, that does not count toward Medicare's coverage limit.

What if my doctor says I need the test but I am under 65 and have no risk factors?

Medicare will not cover it unless you have one of the specific risk factors listed (fracture history, family history, corticosteroid use, or certain medical conditions). If your doctor believes the test is necessary, you can pay out of pocket or ask whether your doctor's office can request a Medicare exception based on your medical situation.

Can I get a bone density test at home?

No. Medicare only covers bone density tests done at a medical facility using a DXA machine. At-home screening devices are not covered by Medicare and are not considered reliable for diagnosis. You must go to a hospital, imaging center, or clinic for the official test.

What should I bring to my bone density test appointment?

Bring your Medicare card and photo ID. Wear comfortable, loose clothing without metal buttons, zippers, or snaps — you may need to change into a gown. Tell the technician about any metal implants (such as hip replacements or pacemakers) before the test begins. The test itself takes 10 to 30 minutes and is painless.