Medicare Coverage for Bone Density Tests: What You Pay and Don't Pay

Medicare covers bone density tests, but only under specific conditions and only certain types

Medicare Part B covers a bone density test (also called a DXA scan or DEXA scan) if you meet one of several conditions. The test itself costs nothing if Medicare covers it — you pay the standard Part B copay, which is 20 percent of what Medicare allows after you have met your deductible. The catch is that Medicare will not pay for the test just because you want one or because your doctor thinks it is a good idea. You must fall into a category Medicare has defined, and your doctor must order it for a reason Medicare recognizes.

The most common reason Medicare covers the test is if you are a woman age 65 or older. Medicare also covers it for men age 70 or older, and for younger people of any gender if they have risk factors — a prior fracture, long-term steroid use, rheumatoid arthritis, or other conditions that weaken bone. If you do not fit one of these groups, Medicare will likely deny the claim, and you will owe the full cost.

Key Takeaways

Medicare Part B covers bone density tests for women 65 and older and men 70 and older without requiring a specific reason.
Younger people can get Medicare coverage if they have a documented risk factor such as a prior fracture, steroid use, or rheumatoid arthritis.
You pay 20 percent of the Medicare-allowed amount after your Part B deductible, not the full test price.
Your doctor must order the test — you cannot order one yourself and expect Medicare to pay.
Medicare will not cover repeat tests more often than once every two years, except in specific medical situations.

Who Medicare covers without a specific medical reason

If you are a woman age 65 or older, Medicare covers a bone density test once every two years with no additional justification needed. Your doctor straightforward orders it, and Medicare pays its share. You do not need to have symptoms, a prior fracture, or any other condition — age and gender are enough.

Men age 70 or older are covered under the same rule. If you are a man between 50 and 69, Medicare will not cover the test based on age alone, but you may still be covered if you have a risk factor your doctor documents.

If you are younger than these ages, you will need to show Medicare that you have a medical reason for the test. straightforward wanting to know your bone density is not enough.

Medical reasons Medicare covers for younger people

If you are under 65 (women) or under 70 (men), Medicare will cover a bone density test if your doctor documents one of these reasons: a prior fracture from minimal trauma (a fall from standing height or less), long-term use of corticosteroids such as prednisone, rheumatoid arthritis, treatment for hyperthyroidism, or certain other bone-weakening conditions. Your doctor must note the reason in your medical record before ordering the test.

Osteoporosis itself — a diagnosis of low bone density from a prior test — is also a covered reason. If you had a bone density test that showed osteoporosis or osteopenia, Medicare will cover follow-up tests to monitor whether treatment is working. However, Medicare limits these follow-up tests to once every two years unless your doctor has documented a reason for more frequent testing.

If your doctor thinks you need the test but you do not fit these categories, ask your doctor to document the medical reason in writing. Medicare reviewers sometimes cover tests that fall outside the standard rules if the medical record shows a clear clinical need.

What the test costs you

If Medicare covers the test, you pay 20 percent of the Medicare-allowed amount after you have met your Part B deductible for the year. The Medicare-allowed amount is not the same as the price the imaging center charges — it is the amount Medicare has decided the test is worth. If the center charges $300 but Medicare allows $200, you pay 20 percent of $200, which is $40 (plus any remaining deductible).

The Part B deductible for 2024 is $240 per year. Once you have paid $240 out of pocket for Part B services in a calendar year, your 20 percent copay kicks in for the rest of the year. If you have already met your deductible, you owe only the 20 percent copay.

If Medicare denies the claim because you do not meet the coverage rules, you will owe the full cost. The imaging center will bill you directly, and the bill can range from $200 to $500 depending on the facility and your location.

How to make sure Medicare will pay before you get the test

Ask your doctor to order the test in writing and to note the medical reason — your age, your prior fracture, your steroid use, or whatever applies to you. When you call to schedule the test, tell the imaging center that you have Medicare and ask them to verify coverage before your appointment. Most centers will submit a pre-authorization request to Medicare, which takes a few days and tells you whether Medicare will pay.

If the center says Medicare will not cover it, ask them to explain why. Sometimes the reason is that your doctor did not document a covered reason, and a quick call to your doctor's office to add that information will fix it. Other times, Medicare has decided you do not meet the rules — for example, if you had a bone density test less than two years ago, Medicare may deny a second test as too soon.

Do not assume the center's initial answer is final. If Medicare denies the claim, you have the right to ask Medicare to reconsider. Your doctor can submit additional medical information to support the request.

Repeat tests and the two-year rule

Medicare will not pay for a bone density test more often than once every two years, with rare exceptions. If you had a test covered by Medicare in January 2024, Medicare will not cover another test until January 2026 or later. If your doctor orders a test sooner, Medicare will deny it, and you will owe the cost.

The exception is if you are being treated for osteoporosis and your doctor has documented that you need more frequent monitoring — for example, if you are on a new medication and your doctor wants to check whether it is working. Even then, Medicare requires documentation of the medical reason before it will approve a test sooner than two years.

If you are unsure whether enough time has passed since your last test, ask your doctor's office to check your Medicare records or call Medicare directly at 1-800-MEDICARE to ask when your last covered test was.

What happens if Medicare denies the claim

If Medicare denies the claim, the imaging center will send you a notice called an Explanation of Benefits (EOB). The notice will say why Medicare denied it — usually because you do not meet the age or medical reason requirements, or because you had a test too recently.

You have the right to ask Medicare to reconsider. You can ask your doctor to submit a letter explaining why the test was medically necessary, and you can submit it along with a written request for reconsideration. Mail it to the Medicare contractor listed on your EOB. The process takes several weeks.

If Medicare still denies it after reconsideration, you can file an appeal, but you will likely owe the cost of the test in the meantime. If the amount is significant, it may be worth asking whether your doctor can document a reason that fits Medicare's rules, or whether waiting until you meet the age requirement makes sense.

Frequently Asked Questions

Can I get a bone density test if I am 55 and have no fracture history?

Not through Medicare unless you have a documented medical reason such as rheumatoid arthritis, long-term steroid use, or treatment for hyperthyroidism. If you do not have one of these conditions, Medicare will not cover it. You can pay out of pocket, or you can wait until you are 65 (if you are a woman) or 70 (if you are a man).

Will Medicare pay if my doctor says I need the test but I had one two years ago?

Not unless your doctor documents a specific medical reason for more frequent testing, such as treatment for osteoporosis with a new medication. The standard rule is once every two years. If your doctor believes you need it sooner, have them submit a written request to Medicare explaining the clinical reason.

What if the imaging center says Medicare will not cover it?

Ask the center why. If the reason is that your doctor did not document a covered reason, call your doctor's office and ask them to add it to your order. If the reason is that you had a test too recently or do not meet the age requirement, the center is likely correct, and you will owe the cost if you proceed.

Do I need to do anything special to get Medicare to pay?

Make sure your doctor documents the reason for the test in your medical record before ordering it. When you schedule, ask the imaging center to verify coverage with Medicare before your appointment. This takes a few days but prevents surprises.

What is the difference between a bone density test and a bone scan?

A bone density test (DXA scan) measures how dense your bones are and is used to screen for osteoporosis. A bone scan is a different test that uses radioactive dye to look for fractures, infections, or cancer. Medicare covers bone density tests under different rules than bone scans, so make sure your doctor is ordering the right one.

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.