Medicare covers one bone density test every 24 months if you meet the risk criteria

Medicare Part B pays for a bone density test (also called a DXA scan or DEXA scan) once every two years if you are at risk for osteoporosis. The test itself is covered at 80 percent after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers the cost-sharing.

The 24-month window resets from the date of your last test, not from the calendar year. If you had a bone density test on March 15, 2023, Medicare will not cover another one until March 15, 2025. If your doctor orders one before that date, you will be responsible for the full cost unless your plan covers it separately.

Some people are covered more frequently. If you are taking certain medications (like corticosteroids) or have specific medical conditions, your doctor may request coverage more often, and Medicare may approve it. The decision depends on your individual health situation and what your doctor documents in your medical record.

Key Takeaways

  • Medicare Part B covers one bone density test every 24 months if you meet risk criteria, paying 80 percent of the cost after your deductible.
  • The 24-month period is measured from your last test date, not from January 1, so timing matters when scheduling a repeat scan.
  • You pay 20 percent of the Medicare-approved amount unless your Medigap or Medicare Advantage plan covers the remaining cost-sharing.
  • More frequent testing may be covered if you take corticosteroids or have conditions that increase osteoporosis risk, but your doctor must request it and Medicare must approve it.

Who qualifies for Medicare coverage of bone density tests

Medicare covers bone density screening for women age 65 and older, and for men age 70 and older, without any additional risk criteria. You do not need to have symptoms or a prior fracture to be covered at these ages.

Younger people (men under 70 and women under 65) can also be covered if they have risk factors. These include a personal history of fracture as an adult, a family history of osteoporosis, low body weight, use of corticosteroid medications, or certain medical conditions like rheumatoid arthritis or chronic kidney disease. Your doctor must document one of these risk factors in your medical record for Medicare to cover the test.

If you have Medicare Advantage instead of Original Medicare, the coverage rules are the same, but you may have different out-of-pocket costs. Check your plan documents or call your plan to confirm what you will owe.

What happens when you need a test before 24 months have passed

If your doctor believes you need another bone density test before 24 months have passed since your last one, they can request an exception. Medicare calls this a "medical necessity" request. Your doctor submits documentation explaining why the test is medically necessary — for example, because you started a new medication, had a fall or fracture, or your condition has changed.

Medicare reviews the request and either approves or denies it. Approval is not may provide. If Medicare denies the request, you can ask your doctor to appeal, or you can pay out of pocket. The cost of a bone density test without insurance typically ranges from $100 to $300, depending on the facility and your location.

Do not assume the test will be covered just because your doctor orders it. Ask your doctor's office to check with Medicare before the test is scheduled, or call Medicare yourself at 1-800-MEDICARE to confirm coverage.

How to learn about you are due for a bone density test

Your doctor should track when your last bone density test was performed and remind you when you are may be able to access for another one. If you have not had a test in the past two years and you are age 65 or older (or age 50 or older with risk factors), ask your doctor whether a test is right for you.

You can also contact your Medicare plan directly. Call the customer service number on your Medicare card and ask whether you are covered for a bone density test. Have your date of last test ready, if you know it. If you do not have records of a prior test, your doctor's office can look it up in their system.

Some Medicare Advantage plans send reminders about preventive care, including bone density screening. Check any materials your plan sends you, or log into your plan's website to see what preventive services you are due for.

What to expect during the test and what it costs you

A bone density test is a quick, painless scan that usually takes 10 to 30 minutes. You lie on a table while a machine passes over your bones, typically your hip, spine, and forearm. There is no injection, no radiation exposure beyond a very small amount, and no recovery time. You can go home and resume normal activities when ready.

The test is usually done at a hospital, imaging center, or your doctor's office. Medicare pays the facility a set amount for the test. You are responsible for 20 percent of that amount after you meet your Part B deductible ($240 in 2024, though this changes yearly). If you have already met your deductible for the year, you pay 20 percent of the approved amount only. If you have not met it, you pay the full deductible first, then 20 percent of the remaining cost.

Ask the facility for an estimate before your test. They can tell you what Medicare will pay and what your 20 percent share will be. If you have a Medigap plan (Plan C, D, F, G, M, or N), it typically covers the 20 percent cost-sharing, so you may owe nothing out of pocket.

What to do if Medicare denies coverage

If Medicare denies coverage for your bone density test, you will receive a notice called an Explanation of Benefits (EOB). This notice explains why Medicare denied the claim. Common reasons include: the test was performed before 24 months had passed since your last test, you do not meet the age or risk criteria, or the test was ordered by a provider who is not enrolled in Medicare.

You have the right to appeal. You can ask your doctor to submit additional medical information supporting the need for the test, or you can file a formal appeal with Medicare. The appeal process has multiple levels, and you can request a hearing if you disagree with the decision. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to start an appeal.

If you believe the denial is incorrect, you can also pay out of pocket and then request reimbursement from Medicare if you win your appeal. Keep all receipts and documentation of your appeal in case you need them later.

Bone density testing and other preventive care covered by Medicare

Bone density screening is one of several preventive services Medicare covers at no cost-sharing (meaning you pay nothing after your deductible) for people who meet the criteria. Other preventive services include mammograms, colonoscopies, cardiovascular screening, and diabetes screening.

However, bone density tests are not always fully covered with no cost-sharing. The coverage depends on whether you meet Medicare's criteria and whether you are within the 24-month window. If you do not meet the criteria or are outside the window, you pay the full 20 percent cost-sharing.

Talk to your doctor about which preventive services are right for you based on your age and health history. Medicare has a full list of covered preventive services on Medicare.gov.

Frequently Asked Questions

Can I get a bone density test more than once every 24 months?

Yes, but only if your doctor requests it and Medicare approves it as medically necessary. Common reasons include starting corticosteroid medications, having a fracture, or having a condition that increases osteoporosis risk. Your doctor must submit documentation with the request. If Medicare denies it, you can pay out of pocket or ask your doctor to appeal.

Do I have to pay anything if I have a Medigap plan?

Most Medigap plans cover the 20 percent cost-sharing for bone density tests, so you may owe nothing out of pocket. Check your plan documents or call your plan to confirm. Plans C, D, F, G, M, and N typically cover this cost-sharing.

What if I had a bone density test at a private facility before I turned 65?

Medicare does not count tests performed before you were enrolled in Medicare. The 24-month window starts from your first Medicare-covered test. If you had a test before age 65, you are still covered for a test once you turn 65 and meet Medicare's criteria.

How do I know if I have already met my Part B deductible?

Check your Explanation of Benefits (EOB) statements from earlier in the year, or call Medicare at 1-800-MEDICARE. Your Medicare plan can also tell you how much of your deductible you have used. The deductible resets on January 1 each year.

What if my doctor says I need a test but Medicare says I do not meet the criteria?

Ask your doctor to submit a detailed request to Medicare explaining your specific risk factors or medical conditions. Medicare may approve coverage based on medical necessity even if you do not fit the standard criteria. If Medicare denies it, you can pay out of pocket or ask your doctor to appeal the decision.