Medicare Part B covers DEXA bone density scans as a preventive service, and you pay nothing when your provider accepts Medicare assignment. So the short answer to whether Medicare covers DEXA scans is yes, with two conditions: you have to meet at least one of five qualifying medical criteria, and you generally can’t have had another covered scan in the past 23 months.1Medicare.gov. Bone Mass Measurements Get those details right and the scan is fully covered. Miss them and you can end up with the full bill.
Who Qualifies for a Covered Scan
Federal law defines five categories of “qualified individuals” for a covered bone mass measurement.2Office of the Law Revision Counsel. 42 US Code 1395x – Definitions You only need to fit one:
- You’re an estrogen-deficient woman at clinical risk for osteoporosis, as determined by your doctor based on your medical history and other findings.
- An X-ray shows vertebral abnormalities suggesting osteoporosis, osteopenia, or a vertebral fracture.
- You’re taking prednisone or another steroid-type drug for the long term, or you’re about to start.
- You’ve been diagnosed with primary hyperparathyroidism.
- You’re on an FDA-approved osteoporosis medication and your doctor needs to monitor whether it’s working.
Four of those five apply regardless of sex. The estrogen-deficiency criterion is limited to women, but men who meet any of the other four qualify for full coverage.1Medicare.gov. Bone Mass Measurements A doctor or other qualified provider has to order the scan and document why you meet the criteria. Without that documentation, Medicare denies the claim.
How Often Medicare Pays for a Scan
Medicare covers a bone mass measurement once every 24 months for qualifying individuals. The clock runs from the month of your last covered scan, and at least 23 months have to pass before Medicare pays for the next one.3Centers for Medicare & Medicaid Services. LCD – Bone Mass Measurement (L36460) So a January 2025 scan means the earliest next covered scan is December 2026.
A shorter interval is allowed when it’s medically necessary. Situations that can justify one include:
- Your original scan used a different testing method than the one now being proposed, and a new baseline is needed.
- You’ve been on glucocorticoid or anticonvulsant therapy for more than three months and need closer monitoring.
- Your primary hyperparathyroidism hasn’t been controlled, so bone loss may be moving faster than the standard schedule can track.
Your doctor has to document exactly why the earlier scan is warranted. A claim filed before 23 months without that documentation will almost certainly be denied.4Centers for Medicare & Medicaid Services. NCD – Bone (Mineral) Density Studies (150.3)
What You Actually Pay
A covered DEXA scan isn’t subject to the usual 20% Part B coinsurance. Because it’s classified as a preventive service, you pay nothing when your provider accepts assignment.5Medicare.gov. Medicare and You 2026 The Part B annual deductible ($283 in 2026) doesn’t apply either.6Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
The condition to watch is that phrase “accepts assignment.” A provider who accepts assignment agrees to take Medicare’s approved amount as full payment. Most providers who treat Medicare patients do, but they aren’t all required to. A provider who doesn’t accept assignment can charge up to 15% above the Medicare-approved amount, and you’d owe the difference. Before scheduling, confirm that both the ordering physician and the facility performing the scan accept assignment.
How Medicare Advantage Handles DEXA Scans
Medicare Advantage plans have to cover everything Original Medicare covers, including bone mass measurements under the same qualifying conditions, and the $0 preventive benefit applies.7Medicare.gov. Understanding Medicare Advantage Plans What changes is the rules around getting to that coverage.
Many Advantage plans require you to use in-network providers, get a referral from your primary care doctor, or obtain prior authorization before the scan. Original Medicare generally doesn’t require prior authorization for DEXA scans, but your Advantage plan might. Skipping those steps can trigger a denial even when the scan itself is medically appropriate. Call the number on your plan card before scheduling and ask three things: Do I need a referral? Do I need prior authorization? Is this facility in network?
Why Claims Get Denied
Most denials are paperwork failures, not medical disagreements. The CMS national coverage determination for bone density studies flags several recurring patterns:4Centers for Medicare & Medicaid Services. NCD – Bone (Mineral) Density Studies (150.3)
- The ordering provider didn’t include notes explaining why you qualify. This is the most common and most preventable denial.
- The facility can’t verify that a treating physician or qualified provider ordered the scan.
- The claim was submitted without a diagnosis code matching Medicare’s covered conditions.
- The scan happened less than 23 months after the last covered measurement, with no documentation justifying the shorter interval.
- The scan was ordered as a general screening rather than for a specific covered condition. Medicare only pays for bone density tests when you meet at least one of the five qualifying criteria.
If your provider suspects Medicare won’t cover the scan, they’re required to give you an Advance Beneficiary Notice of Noncoverage (ABN) before performing it.8Centers for Medicare & Medicaid Services. Advance Beneficiary Notice of Non-coverage Tutorial The ABN lets you decide whether to go ahead and pay out of pocket or cancel. If they perform the scan without giving you an ABN when they should have, the provider may be on the hook for the cost rather than you.
Appealing a Denied Claim
If Medicare denies your DEXA scan claim, the first step is a redetermination request filed with the Medicare Administrative Contractor that processed the original claim. You have 120 days from the date you receive the denial notice to file. Medicare presumes you received the notice five days after it was mailed, so in practice your window is about 125 days from the mailing date.9Centers for Medicare & Medicaid Services. First Level of Appeal – Redetermination by a Medicare Contractor
The request has to be in writing. You can use the official CMS-20027 form or send a letter that includes your name, Medicare number, the specific service and date, and an explanation of why you disagree. Attach everything that supports your case: your doctor’s notes documenting medical necessity, the physician’s order, and any relevant diagnostic records. Contact information for your MAC is on your Medicare Summary Notice. Additional appeal levels are available if the redetermination goes against you, but most bone density denials that get overturned are won at the first level, because the underlying issue is usually missing documentation that can be supplied after the fact.
What a DEXA Scan Costs Without Coverage
If you don’t meet any of the five criteria, or your claim is denied and you don’t appeal, you pay the full cost yourself. Cash prices for a medical-grade bone density scan at a hospital or imaging center generally run $150 to $400, and that sometimes doesn’t include a separate radiologist’s interpretation fee of $50 to $100. Wellness-oriented facilities that focus on body composition rather than diagnosing osteoporosis charge less, but those results may not be accepted by your doctor for clinical decisions. Before paying out of pocket, ask your provider whether additional documentation could bring the scan within Medicare’s qualifying criteria. A scan ordered for the right reason with proper documentation is always better than one you pay for yourself.