Bone Density Scan Coverage: When Medicare and Insurance Pay for a DXA

Bone loss speeds up after menopause, and a bone density scan, usually a DXA (dual-energy X-ray absorptiometry), is how it’s measured. The test is quick and painless. The bill depends on your age, your risk factors and how it’s ordered. Here is how coverage works and what to check before you book.

Who screening is recommended for

The U.S. Preventive Services Task Force (USPSTF)¹ recommends osteoporosis screening for:¹

• All women 65 and older.
• Postmenopausal women under 65 at increased risk of fracture, based on a clinical risk assessment.

Risk factors it lists include low body weight, a parent who broke a hip, smoking and drinking too much alcohol. Conditions and medicines such as corticosteroids can also raise risk.¹

Private insurance and Marketplace plans

HealthCare.gov² says Marketplace plans and many other plans must cover bone density screening for women over 65, and for younger women who have gone through menopause, without a copay or coinsurance, even before you meet your deductible.²

The fine print: coverage generally applies when you use an in-network provider, and HealthCare.gov² notes that $0 cost isn’t guaranteed in all cases.²

Medicare

Medicare Part B covers bone mass measurements once every 24 months, or more often if medically necessary. You pay nothing if your provider accepts assignment.³

You qualify if you meet one or more conditions, including:³

• Your doctor determines you’re estrogen-deficient and at risk for osteoporosis.
• X-rays show possible osteoporosis, osteopenia or spine fractures.
• You take, or are about to start, prednisone or similar steroid drugs.
• You have primary hyperparathyroidism.
• You’re being monitored to see if your osteoporosis medicine is working.

A heel scan isn’t a DXA

Pharmacies and health fairs sometimes offer quick heel or wrist scans. The USPSTF describes screening as a central DXA, which measures the hip and spine.¹ If a quick scan flags a problem, ask your clinician whether you need a DXA.

How often to repeat it

Medicare’s 24-month rule is a coverage limit, not a medical schedule. The USPSTF notes studies suggesting that repeating a scan within 4 to 8 years doesn’t improve fracture prediction for many people.¹ Your clinician may suggest a different timing based on your results, treatment and risk.

Before you book

1. Ask your clinician to order it and note your risk factors or reason for testing.
2. Call your plan to confirm the scan is covered, how often, and whether the imaging center is in network.
3. On Medicare, ask whether the provider accepts assignment, and when your last covered scan was.³
4. Use the same facility for repeat scans when you can, so results are easier to compare.
5. Ask for a copy of your report. Our guide to T-scores and Z-scores explains the numbers.

Try: “I’m 58, went through menopause at 50, and my mother broke her hip. Do I qualify for a bone density scan now, and how should it be ordered so my plan covers it?”

My Body Changed. Now What? includes a Visit Brief. Use it to list your risk factors, medicines and past scan dates for your appointment. See the book.