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

Medicare Part B pays for 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 can also receive coverage once every two years. If you are a man between 50 and 69 with risk factors, you may be covered as well. The test itself is painless and takes about 10 to 30 minutes.

The 24-month window means if you had a bone density test on January 15, 2024, Medicare will not pay for another one until January 15, 2026 or later. If you have the test done before that date, you will likely owe the full cost yourself. Some situations allow for more frequent testing — your doctor can request coverage outside the standard schedule if you are taking certain medications or have had a fracture, but Medicare must approve this before the test.

Key Takeaways

  • Women 65 and older, and women 50 to 64 with osteoporosis risk factors, are covered once every 24 months under Medicare Part B.
  • Men 70 and older are covered once every 24 months; men 50 to 69 with risk factors may also be covered on the same schedule.
  • Your doctor orders the test and Medicare determines whether you meet the criteria; you do not need to contact Medicare directly beforehand.
  • If you need testing more often than every 24 months, your doctor can request an exception, but Medicare must approve it in advance.
  • You typically pay 20 percent of the cost after you have met your Part B deductible, unless you have supplemental coverage.

Who qualifies for bone density screening under Medicare

You may have access to automatically if you are a woman age 65 or older. You do not need to ask or prove anything — your age alone makes you may be able to access for one test every 24 months.

If you are a woman between 50 and 64, you may have access to if you have at least one risk factor for osteoporosis. Risk factors include a personal history of fracture as an adult, a family history of osteoporosis or fracture, low body weight, current smoking, or use of corticosteroid medications. Your doctor determines whether you have a may have access to risk factor based on your medical history and current health.

Men age 70 and older are covered on the same schedule as women 65 and older. Men between 50 and 69 may be covered if they have risk factors, though coverage for men in this age group is less common and depends on individual circumstances. Your doctor will know whether your situation qualifies.

What happens during the 24-month waiting period

Once Medicare pays for a bone density test, the clock starts. You cannot have another test paid for by Medicare until 24 months have passed from the date of your previous test. If your doctor orders a second test before that time, Medicare will deny the claim and you will receive a bill for the full cost.

If you believe you need testing sooner — for example, because you started a new medication that affects bone health, or because you had a fall or fracture — your doctor can submit a request for an exception. Medicare calls this a "coverage information request." Your doctor explains the medical reason why more frequent testing is necessary. Medicare reviews the request and either approves or denies it. This process usually takes a few days to a week. Do not have the test done before you receive approval, or you will owe the cost.

What you pay for a bone density test

Under Medicare Part B, you pay 20 percent of the approved amount for the test after you have met your annual Part B deductible. The deductible amount changes each year; in 2024 it was $240. Once you reach that deductible through other Part B services or this test, you pay only 20 percent of future Part B costs for the rest of the year.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20 percent cost-sharing. If you have a Medicare Advantage plan, your out-of-pocket cost depends on your specific plan — some cover bone density tests with no cost-sharing, while others charge a copay. Check your plan documents or call the plan directly to find out what you will owe.

The actual cost of a bone density test varies by location and facility. Medicare's approved amount typically ranges from $100 to $200, but the facility may charge more or less. You will receive an explanation of benefits (EOB) after the test showing what Medicare paid and what you owe.

How to arrange a bone density test through Medicare

Start by talking to your primary care doctor or a specialist such as an endocrinologist or rheumatologist. Tell them you would like a bone density test. Your doctor will review your age and risk factors and decide whether the test is medically necessary. If your doctor agrees, they will order the test and send the order to an imaging facility.

You do not contact Medicare directly to request the test. Your doctor's office handles the medical decision and the order. The imaging facility will verify your Medicare coverage when you arrive for the appointment. Bring your Medicare card and any other insurance cards you have.

If you do not have a regular doctor, you can start by calling your local health department or a community health center to find a primary care provider who accepts Medicare. Once you have a doctor, you can discuss bone density screening at your next visit.

Bone density test results and follow-up

After your test, a radiologist reads the images and produces a report. Your doctor will discuss the results with you. The report uses a T-score to measure your bone density compared to a healthy young adult. A T-score of -1.0 or higher is considered normal. A score between -1.0 and -2.5 indicates low bone mass (sometimes called osteopenia). A score of -2.5 or lower indicates osteoporosis.

If your results show low bone mass or osteoporosis, your doctor may recommend treatment, lifestyle changes, or both. Treatment options include medications, vitamin D and calcium supplements, weight-bearing exercise, and fall prevention strategies. Your doctor will explain what the results mean for you and what steps to take next.

Even if your first test is normal, you may be due for another test in 24 months. Your doctor will let you know when to schedule your next screening. Some people with normal results may not need another test for several years, depending on their age and risk factors — your doctor will advise you on the right timing.

When Medicare may not pay for bone density testing

Medicare will not pay if you do not meet the age and risk factor requirements listed above. If you are a man under 50, or a woman under 50 without a specific medical reason, Medicare does not cover bone density screening as a preventive measure.

Medicare also will not pay for a second test within 24 months of your previous test, unless your doctor has received prior approval for an exception. If you have the test done at a facility that is not enrolled in Medicare, or if you go to an out-of-network facility under a Medicare Advantage plan, you may owe more or the entire cost.

Some facilities may ask you to pay upfront and then submit the bill to Medicare yourself. This is uncommon, but if it happens, ask the facility whether they are a Medicare provider and whether they will bill Medicare directly. Most imaging centers that perform bone density tests are Medicare providers and will handle billing for you.

Frequently Asked Questions

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

Only if your doctor requests and Medicare approves an exception. Common reasons for approval include starting osteoporosis medication, a recent fracture, or a significant change in your health. Your doctor submits the request before the test is scheduled. Do not have the test done without approval, or you will owe the full cost.

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

If you had a test paid for by Medicare before age 65 (because you had risk factors), the 24-month clock started from that test date. You cannot have another Medicare-covered test until 24 months have passed from that earlier test, even though you are now 65 and automatically may be able to access.

Does Medicare Advantage cover bone density tests the same way?

Medicare Advantage plans must cover bone density screening at least as often as Original Medicare does, but your out-of-pocket cost may be different. Some plans charge a copay, others charge coinsurance, and some cover it with no cost-sharing. Check your plan's summary of benefits or call the plan to find out what you will owe.

What if my doctor says I need a bone density test but I do not meet Medicare's criteria?

If your doctor believes the test is medically necessary even though you do not meet the standard criteria, they can submit a coverage information request to Medicare explaining the medical reason. Medicare will review the request. If approved, Medicare will pay. If denied, you can ask your doctor whether the test is still worth paying for out of pocket.

Will Medicare pay for a bone density test at a hospital versus an imaging center?

Yes, as long as the facility is enrolled in Medicare and the test meets coverage rules. The cost to you may differ depending on whether the test is done at a hospital outpatient department or an independent imaging center, but Medicare's coverage rules are the same. Ask your doctor's office where they usually send patients for bone density testing.