Free Guide to Medicare Bone Density Test Coverage

Understanding Medicare Bone Density Testing

A bone density test, also called a DXA scan or DEXA scan, measures how much mineral is packed into your bones. This test uses a small amount of X-ray technology to take images of your bones and compare them to a healthy young adult's bones. The test takes about 10 to 30 minutes and is painless. Most commonly, doctors examine the hip, spine, and sometimes the forearm because these areas are most prone to fracture.

Medicare covers bone density testing for people at risk of developing osteoporosis, a condition where bones become weak and break more easily. According to the National Osteoporosis Foundation, about one in three women over age 70 and one in five men over age 70 experience osteoporosis-related fractures. Bone density tests help doctors catch bone loss early, before serious fractures occur.

The test produces 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 osteopenia, or bone loss that is not yet osteoporosis. A score of -2.5 or lower suggests osteoporosis. These scores help doctors determine whether you need treatment or monitoring.

Different types of bone density tests exist. The standard DXA scan is the most common and is what Medicare typically covers. Other methods like quantitative computed tomography (QCT) or ultrasound tests may also be performed, though coverage varies. Understanding what type of test your doctor recommends and why can help you prepare for the appointment.

Practical Takeaway: Before scheduling a bone density test, learn what a normal score looks like and what different results mean. This background knowledge helps you better understand your results and discuss treatment options with your healthcare provider if needed.

Who May Be Covered Under Medicare Part B

Medicare Part B covers bone density testing for certain groups of people. Understanding whether you fall into these categories is the first step in learning about your coverage options. Medicare Part B is the portion of Original Medicare that covers doctor visits, outpatient services, and diagnostic tests like bone density screening.

Women age 65 and older may receive coverage for a bone density test once every 24 months. This applies to postmenopausal women, as bone loss accelerates after menopause due to declining estrogen levels. Women in this age group represent a large portion of those diagnosed with osteoporosis—about one in three women over 70 experiences an osteoporosis-related fracture during her lifetime.

Men age 70 and older may also receive coverage once every 24 months. Men develop osteoporosis later in life than women, and it is often overlooked. However, according to the National Institutes of Health, about one in four men over age 50 will break a bone due to osteoporosis.

Younger individuals—both women and men under the typical screening ages—may receive coverage if they meet specific risk factors. These risk factors include having a condition associated with bone loss, taking medications that reduce bone density (such as corticosteroids), or having already experienced a fracture that suggests bone loss. Individuals with a personal or family history of osteoporosis, those with certain diseases affecting the endocrine system, or those with kidney or liver disease may also be candidates for testing.

People enrolled in Medicare Advantage plans (Part C) may also receive bone density testing coverage, though the specific rules may differ from Original Medicare. It is important to review your individual plan documents to understand your coverage.

Practical Takeaway: Write down your age, medical history, current medications, and any previous fractures. Review these details against the coverage categories to understand where you may fit. If you are uncertain, your doctor can help determine whether a bone density test is medically appropriate for you.

Coverage Details and Cost Information

Under Original Medicare Part B, bone density tests are typically covered with a 20% coinsurance after you have met your annual deductible. The deductible amount changes yearly—for 2024, the Part B deductible is $240. This means Medicare pays 80% of the approved amount for the test, and you pay the remaining 20%.

The actual cost you pay depends on the approved amount Medicare sets for the test in your geographic area. Approved amounts vary by location and facility type. For example, a bone density test performed at a hospital outpatient department may have a different approved amount than one performed at an independent imaging center. The typical approved amount for a standard DXA scan ranges from $80 to $150, meaning your 20% coinsurance would typically fall between $16 and $30.

If you have not yet met your Part B deductible for the year, you would pay the full deductible amount first, then your 20% coinsurance on top of that. Once you reach your annual out-of-pocket maximum—$308 per year for Part B beneficiaries in 2024—Medicare covers 100% of additional bone density tests that year.

Supplemental insurance, also called Medigap, can help cover your coinsurance costs. Some Medigap plans cover the full 20% coinsurance, while others cover part of it. If you have Medicaid in addition to Medicare, Medicaid may help pay some of your costs.

Medicare Advantage plans (Part C) have different cost structures. Some plans may charge a copay for the test (such as $0, $25, or $50), while others may use coinsurance. You should review your specific plan's formulary and cost-sharing information to understand what you would pay.

Practical Takeaway: Call your imaging facility or doctor's office and ask for the Medicare-approved amount for a bone density test. Then calculate what you would owe based on whether you have met your deductible. If you have Medigap or Medicaid, ask how much of your coinsurance these programs would cover.

Finding a Medicare-Approved Provider

To receive coverage, your bone density test must be ordered by a doctor and performed at a Medicare-approved facility. Medicare covers tests performed at hospitals, independent imaging centers, physician offices, and other outpatient settings. The key requirement is that the facility is enrolled in the Medicare program.

Your primary care doctor or specialist can order a bone density test if they believe you have risk factors for bone loss. You do not need to see a specialist—a primary care physician can order the test. Once your doctor orders the test, you will receive instructions on where to have it performed. Many times, your doctor's office will have a preferred facility where they regularly send patients.

To verify that a facility is Medicare-approved, you can use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), available at the Centers for Medicare & Medicaid Services website. This searchable database allows you to enter a facility name or location to confirm it is enrolled in Medicare. You can also call 1-800-MEDICARE to ask whether a specific facility is Medicare-approved.

When scheduling your test, inform the facility that you have Medicare and that you want to receive Medicare coverage. The facility staff can verify your coverage before your appointment and explain your costs. It is reasonable to contact multiple facilities if you want to compare costs or locations. Some facilities may be more convenient to your home, while others may have shorter wait times for appointments.

If your doctor refers you to a facility that is not Medicare-approved, ask whether the facility can transfer your order to a Medicare-enrolled location, or ask your doctor for a referral to an alternative facility. You can also contact your local hospital or imaging center directly to ask about bone density testing services.

Practical Takeaway: Before scheduling, verify the facility is Medicare-approved using the PECOS database or by calling 1-800-MEDICARE. Ask the facility staff to confirm your Medicare coverage and explain your expected costs before you arrive for your appointment.

What Happens Before, During, and After Your Test

Preparing for a bone density test requires minimal effort on your part. You should wear comfortable, loose-fitting clothing without metal fasteners, zippers, or buttons, as metal can interfere with the X-ray images. You may wear regular clothes and stay dressed during most of the test—only the area being scanned needs to be exposed. Avoid wearing jewelry or removable metal