Yes. Medicare Part B covers DEXA scans as a preventive service, and you pay nothing out of pocket when your provider accepts Medicare assignment and you meet at least one of five qualifying conditions.1Medicare.gov. Bone Mass Measurements Coverage runs on a 24-month cycle, with earlier retesting allowed when your doctor documents a medical reason.
Who Qualifies for a Covered Scan
Federal law lists five categories of “qualified individuals” eligible for a Medicare-covered bone mass measurement.2Office of the Law Revision Counsel. 42 U.S. Code 1395x – Definitions You only need to meet one:
- You are a woman whose doctor has determined you are estrogen-deficient and at clinical risk for osteoporosis based on your medical history.
- An X-ray has shown possible osteoporosis, low bone mass, or a vertebral fracture.
- You are taking, or about to start, prednisone or a similar steroid medication long-term.
- You have been diagnosed with primary hyperparathyroidism.
- You are on an FDA-approved osteoporosis drug and your doctor needs to check whether it is working.
Four of the five conditions are gender-neutral, so men qualify under the same rules as women for everything except the estrogen-deficiency category.1Medicare.gov. Bone Mass Measurements A man on long-term steroids has the same coverage as a woman in the same situation. If you don’t meet any of these conditions, Medicare won’t pay and you’d owe the full cost of the scan.
How Often Medicare Pays
The general rule is once every 24 months. To be precise, at least 23 months must have passed since your last covered bone mass measurement before Medicare will pay for another.3eCFR. 42 CFR 410.31 – Bone Mass Measurement: Conditions for Coverage and Frequency Standards
More frequent scans are allowed when your doctor documents medical necessity. The regulations give two examples: monitoring someone on steroid therapy lasting more than three months, and a confirmatory baseline scan so your doctor has a reference point for later comparison.3eCFR. 42 CFR 410.31 – Bone Mass Measurement: Conditions for Coverage and Frequency Standards Other clinical reasons can qualify too, but your physician needs to document why.
Booking a scan before the 23-month window closes is one of the easiest ways to end up with a surprise bill. If you’re unsure when your last covered scan was, check your Medicare Summary Notice or call 1-800-MEDICARE before scheduling.
What You Pay
When your provider accepts Medicare assignment and you meet a qualifying condition, you pay nothing. No deductible, no coinsurance.1Medicare.gov. Bone Mass Measurements Medicare classifies bone mass measurement as a preventive service, which means full coverage with zero cost-sharing.
The picture changes if your provider doesn’t accept assignment. Non-participating providers can charge up to 15% above the Medicare-approved amount, and you’d owe that excess plus the standard 20% coinsurance after the Part B deductible, which is $283 in 2026.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles For a sense of scale, the Medicare-approved amount for a DEXA scan in 2026 runs from about $68 at an ambulatory surgical center to $145 at a hospital outpatient department.5Medicare.gov. Procedure Price Lookup for Outpatient Services – 77080 Confirm your facility accepts assignment before the scan and you avoid all of this.
If Medicare doesn’t cover the scan at all, because you don’t meet a qualifying condition or the 23-month window hasn’t passed, you owe the full charge. Self-pay prices typically run $100 to $200, though hospital-based facilities often charge more.
Getting the Referral and Paperwork Right
Coverage starts with a referral. Your doctor or another qualified provider must order the test after evaluating your need and determining you meet at least one of the qualifying conditions.6Noridian Medicare. Bone Mass Measurements – JF Part B A verbal recommendation isn’t enough; the order must be documented in your medical record.
Documentation matters more than most patients realize. The ordering physician’s records need to show the clinical reason for the scan, your relevant history, prior test results, and a signed, dated note.7Centers for Medicare & Medicaid Services. Billing and Coding: Bone Mass Measurement The facility performing the scan also has to submit the correct diagnosis code matching your qualifying condition, or the claim comes back as incomplete. The scan must include a written interpretation by a physician filed separately from any office visit notes, or Medicare will deny it as not medically necessary.
Before your appointment, confirm two things with the facility: that they accept Medicare assignment, and that they’ll bill Medicare directly.
If Coverage Is Uncertain: The ABN
If your provider suspects Medicare might not cover your scan, they must give you a written notice called an Advance Beneficiary Notice of Non-Coverage (ABN) before performing the test.8Centers for Medicare & Medicaid Services. Advance Beneficiary Notice of Non-Coverage Tutorial This comes up most often when you’re getting a repeat scan before the 23-month window closes, or when your records don’t clearly support one of the five qualifying conditions.
The ABN gives you a choice: agree to pay out of pocket if Medicare denies the claim, or decline the test. If you agree, pay, and Medicare later denies coverage, you can appeal. If the provider fails to give you an ABN and Medicare denies the claim, the provider bears the cost, not you.
To appeal a denial, start with a redetermination request to the Medicare Administrative Contractor within 120 days of receiving your Medicare Summary Notice.9Centers for Medicare & Medicaid Services. Medicare Appeals Most bone density disputes get resolved at that first level.
What About Two Scans in One Visit
A central DEXA measures bone density at the hip and spine, the sites that matter most for diagnosing osteoporosis. Peripheral devices measure smaller areas like the wrist, heel, or finger. Medicare covers both types, but not both on the same day. Two scans of the same type in one visit will not be paid, and a central and peripheral scan on the same day are not considered medically necessary together.7Centers for Medicare & Medicaid Services. Billing and Coding: Bone Mass Measurement If a peripheral scan is done first and a central DEXA is later needed as a confirmatory baseline, that follow-up can be covered as a separate measurement.
Medicare Advantage and Medigap
Medicare Advantage plans must cover bone mass measurements with at least the same benefits as Original Medicare. Using an in-network provider who accepts your plan, most enrollees pay nothing when they meet a qualifying condition. Advantage plans can impose network restrictions, though, so an out-of-network facility could leave you with higher costs or no coverage. Check your plan’s provider directory before scheduling.
Medigap works differently because it sits on top of Original Medicare. Since Original Medicare already covers the scan at $0 when the provider accepts assignment, Medigap doesn’t come into play for most people getting this test. It becomes relevant only if your provider doesn’t accept assignment, in which case certain Medigap plans cover the Part B excess charge and the 20% coinsurance you’d otherwise owe.