Does Medicare Cover a Dexa Scan? 

Statistics gathered in the United States show that approximately ten million people over the age of 50 have osteoporosis, and over 43 million more people have low bone mass with an increased risk of getting osteoporosis. 

You might have a higher risk for osteoporosis if you:

• Drink alcohol
• Use tobacco products
• Have a low body mass index
• Have rheumatoid arthritis
• Have a sedentary lifestyle
• Have a family history of osteoporosis
• Have had previous bone fractures
• Have lost more than one inch of height in the past years 

Your physician might suggest that you get tested for bone density and your risk of bone fractures if you:

• Are a female and over the age of 65
• Are a male and over the age of 70
• Have a fragility fracture
• Have a disease or condition like osteoporosis, rheumatoid arthritis, or hyperthyroidism which can affect your bone health

A DEXA (dual energy X-ray absorptiometry) scan measures bone density and bone fracture risk using high-precision X-rays. A DEXA scan can help your physician determine your risk of osteoporosis, monitor progression of the disease, and monitor treatment effectiveness. 

DEXA scans are noninvasive, fast, painless, and are covered by Medicare for most beneficiaries who qualify for the benefit. 

Does Medicare cover DEXA scans? 

Original Medicare Part B (medical insurance) covers screenings for osteoporosis as part of its preventive care services. You may be eligible for a DEXA scan to measure bone mass once every 24 months, or more often if your health care provider certifies that it’s medically necessary, if you meet one or more of the following criteria for eligibility:

• You’re female and your health care provider finds that your estrogen levels are deficient. 
• You’re at a higher risk for osteoporosis based on your medical history. 
• X-rays show a possibility of osteoporosis, osteopenia, or fractures in your vertebrae. 
• You’re taking certain prescriptions medications like prednisone or steroid drugs, or you’ll soon begin taking them. 
• Your physician has diagnosed you with primary hyperparathyroidism. 
• Your health care provider is monitoring your progress with osteoporosis drug therapy. 

If you’re eligible for this benefit, Original Medicare Part B covers 100 percent of the cost of a DEXA scan if it’s done by a health care provider who accepts Medicare assignment. 

Medicare beneficiaries who have coverage through Medicare Advantage (MA)plans, are eligible for this benefit if they meet the same criteria as listed above. All Medicare Advantage plans are required to cover at least all the benefits available with Original Medicare Parts A and B. 

However, some Medicare Advantage plans (like HMOs) require that enrollees use health care providers and medical facilities that are included in the plan’s network of accepted providers. Depending on the type of plan you have, you might have to pay 100 percent of the cost for your DEXA scan if you go outside the plan’s network, so check with your provider for details if you aren’t sure what providers you can use. 

How much does a DEXA scan cost without Medicare insurance? 

If you don’t have Medicare coverage, or if you aren’t eligible for a screening for osteoporosis, you may have to pay out-of-pocket for a DEXA scan. Your final cost depends on where you have the scan, but the national average is between $100 and $300. This price includes the scan, the radiologist’s interpretation, and the report for your physician.