Medicare may cover bone density tests if a doctor deems them medically necessary. This may be because a person has osteoporosis, estrogen deficiency, or primary hyperparathyroidism, for example.
If a doctor thinks a person may have osteoporosis or be at risk, they may recommend a bone density scan or dual-energy X-ray absorptiometry (DXA) scan. These scans use an X-ray to measure the amount of minerals, such as calcium, in the bones.
A DXA scan helps diagnose osteoporosis before a person breaks a bone. It can help estimate the chances of breaking a bone and monitor the impact of osteoporosis treatments.
Bone density tests may help prevent expensive reparative treatments. If a doctor says a bone density test is medically necessary, Medicare will typically cover the cost.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare covers bone density tests provided a person meets certain criteria for getting the scan. These criteria may include age and gender as well as personal medical history and risk factors that may put a person at greater risk for decreased bone density.
If a person meets Medicare’s requirements for a bone density scan, they may not have any costs associated with the scan. However, the doctor performing and interpreting the scan must accept Medicare assignment.
In that case, a person does not have to pay copays or the Part B deductible for a bone density scan. Medicare will pay the doctor and the center performing the scan an agreed-upon amount.
As a general rule, a person should check with Medicare before undergoing a bone density scan. Sometimes, a doctor’s office may help a person conduct this check, which is also called a pre-authorization. This process can ensure the doctor accepts assignment and ensures they will not provide services that Medicare does not cover and that a person is then responsible for paying.
Read more about how doctors test for osteoporosis.
Medicare Part B is the Medicare portion responsible for paying for a bone density test. Medicare will cover a test once every 24 months for a preventive screening if they meet the following requirements:
- A doctor certifies a woman is at risk for osteoporosis due to estrogen deficiency or medical history.
- A person’s X-ray shows signs of osteoporosis, osteopenia, or fractured vertebrae.
- A person has been taking medications known to affect bone health, including prednisone or other steroid-type medications.
- A doctor has diagnosed a person with primary hyperparathyroidism, a condition that affects the body’s calcium stores and causes thinning bones.
- A person is undergoing osteoporosis treatments and requires a bone density test to track their treatment’s effectiveness.
A doctor may recommend more frequent bone density tests than Medicare covers. They may also recommend other services not covered by Medicare. This may mean that people will be responsible for paying some or all of the extra costs.
Medicare will only cover DXA scans for men under certain circumstances and people should contact Medicare to check their eligibility.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare will cover bone density scans for people who meet certain medical requirements, such as having osteoporosis risk factors.
People should check with Medicare before having a bone density scan to ensure their plan will cover the cost.
Identifying thinning bone or osteoporosis at early stages before a person breaks a bone can allow them to receive treatments that may help reduce the risk of broken bones.