Medicare covers one bone density test every 24 months if you meet certain conditions

Medicare Part B covers a bone density test (also called a DXA scan or DEXA scan) once every two years if you are a woman age 65 or older, or a woman age 50 to 64 with risk factors for osteoporosis. Men age 70 and older may also be covered if they have risk factors. The test must be ordered by your doctor, and you typically pay 20 percent of the cost after you meet your Part B deductible — Medicare pays the other 80 percent.

The 24-month window means if you had a test on January 15, 2024, Medicare will not cover another one until January 15, 2026. Some people need testing more often due to medical conditions or medications, but Medicare does not cover those additional scans unless your doctor documents a medical reason and submits it for review.

Key Takeaways

  • Medicare Part B covers one bone density test every 24 months for women 65 and older, and for women 50 to 64 with osteoporosis risk factors.
  • Men age 70 and older may be covered if they have risk factors such as low testosterone, chronic kidney disease, or long-term corticosteroid use.
  • Your doctor must order the test and it must be performed at a Medicare-approved facility for the coverage to explore.
  • You pay 20 percent of the approved cost after meeting your Part B deductible; Medicare covers the remaining 80 percent.
  • If you need testing more frequently than every 24 months, your doctor can request a coverage exception, though approval is not may provide.

Who qualifies for Medicare coverage of bone density tests

Women age 65 and older automatically meet the criteria. Women between 50 and 64 are covered if they have at least one risk factor for osteoporosis — this includes a personal history of fracture, a family history of osteoporosis, low body weight, or current use of corticosteroid medications.

Men age 70 and older may have access to if they have risk factors. These include low testosterone levels, a history of fracture after age 50, chronic kidney disease, or long-term use of medications like prednisone that weaken bone. Men under 70 are generally not covered unless they have a documented medical condition that puts them at high risk.

Your doctor determines whether you meet the criteria and orders the test. You do not need to prove your risk factors yourself — your doctor's order is what Medicare uses to decide whether to pay.

What happens if you need a test sooner than 24 months

If your doctor believes you need another bone density test before 24 months have passed, they can request an exception to Medicare's coverage rules. This is called a coverage information request. Your doctor must document a medical reason — for example, a recent fracture, a significant change in your health, or a new diagnosis that affects bone strength.

Medicare will review the request, but there is no may provide it will be approved. The decision depends on whether the medical reason is strong enough to justify testing outside the normal 24-month window. This process typically takes one to two weeks.

If Medicare denies the request, you can pay out of pocket for the test, or you can ask your doctor to appeal the decision. An appeal gives Medicare a second chance to review the medical evidence.

Where to get the test and what to expect

The bone density test must be performed at a Medicare-approved facility. This includes hospitals, imaging centers, and some doctor's offices that have the equipment and meet Medicare standards. Your doctor will know which facilities in your area are approved, or you can call your local hospital to ask.

The test itself is quick and painless — it usually takes 10 to 30 minutes. You lie on a table while a machine scans your hip, spine, and sometimes your forearm. There is no injection, no radiation exposure worth worrying about, and no recovery time. You can go back to your normal activities right away.

Bring your Medicare card and any other insurance cards you have. The facility will verify your coverage before the test. If you have already met your Part B deductible for the year, you will owe 20 percent of the approved cost at the time of service. If you have not met your deductible, you may owe more.

How the 24-month window works in practice

The 24-month period is measured from the date of your last covered test. If you had a test on March 10, 2023, your next covered test cannot be before March 10, 2025. If you have the test on March 9, 2025, Medicare will deny it because you have not yet reached the 24-month mark.

This timing can matter if you are planning ahead. Some people schedule their test early in the year so the next one falls in a different calendar year, which can help with tracking deductibles and out-of-pocket costs. Talk to your doctor about the best timing for your situation.

If you have had a test at a private facility or through another insurance plan before you turned 65 or before you enrolled in Medicare Part B, that test does not count toward the 24-month window. Only tests covered by Medicare Part B are tracked.

What your results mean and next steps

The bone density test produces a score called a T-score, which compares your bone density to that of a healthy young adult. A T-score of -1 or higher is considered normal. A score between -1 and -2.5 indicates low bone density, sometimes called osteopenia. A score below -2.5 means osteoporosis.

Your doctor will explain your results and discuss whether you need treatment. Treatment might include vitamin D and calcium supplements, weight-bearing exercise, or prescription medications that slow bone loss. The goal is to prevent fractures, especially hip, spine, and wrist fractures that can seriously affect your independence.

If your results show low bone density or osteoporosis, your doctor may recommend the next test sooner than 24 months to see whether treatment is working. In that case, they can request a coverage exception as described above.

Cost and what you will pay

The cost of a bone density test varies by location and facility, but Medicare's approved amount is typically between $100 and $200. You pay 20 percent of that approved amount after you meet your Part B deductible.

If you have not met your $240 Part B deductible for 2024 (the amount varies by year), you will owe the full cost of the test until the deductible is met, then 20 percent of the remaining approved cost. If you have already met your deductible, you owe only the 20 percent coinsurance.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Check your plan documents or call your plan to find out what you will owe.

Frequently Asked Questions

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

Medicare does not routinely cover tests more frequently than every 24 months. However, your doctor can request an exception if there is a medical reason — such as a new fracture, a significant change in your health, or a medication change that affects bone strength. Medicare will review the request, but approval is not may provide.

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

You need an order from a doctor, but it does not have to be your primary care doctor. Any doctor who treats you — including a rheumatologist, orthopedist, or endocrinologist — can order the test. The facility performing the test will verify that the order is valid before you arrive.

What if I had a bone density test before I turned 65 or enrolled in Medicare?

Tests performed before you were covered by Medicare Part B do not count toward the 24-month window. Your Medicare coverage period starts fresh. If you had a test three months before you turned 65, you can have another covered test three months after you turn 65.

Will Medicare cover the test if I go to an out-of-network facility?

The facility must be Medicare-approved for Medicare to pay. If you go to a facility that is not approved, Medicare will not cover the cost. Before you schedule the test, confirm with the facility that it is Medicare-approved, or ask your doctor which approved facilities are near you.

What happens if Medicare denies my test?

If Medicare denies coverage — for example, because you had a test less than 24 months ago — you can pay out of pocket, or your doctor can appeal the decision. An appeal asks Medicare to reconsider based on medical evidence. You can also ask the facility whether they offer a cash discount if you pay directly.