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# A Practical Guide to Medicare Reimbursement for Bone Density Scans
- URL: https://blog.groovehealth.com/what-is-the-medicare-reimbursement-for-a-bone-density/
- Published: 2026-08-07T07:05:24.000Z
- Updated: 2026-08-19T20:28:41.000Z
- Description: Medicare Part B covers bone density scans as a preventive service once every 24 months. Here are the 2026 CPT codes and reimbursement rates, who qualifies, and the billing mistakes that trigger denials.
- Author: Groove Editorial Team
- Tags: Medicare, DXA Scan, Bone Density, Osteoporosis

## How Does Medicare Reimbursement for Bone Density Scans Work?

A bone density scan is most often done with a DEXA scan, which stands for dual-energy X-ray absorptiometry. It is a quick, painless, low-dose X-ray test that measures bone mineral density, usually in the hip and spine. Doctors use it to diagnose osteopenia or osteoporosis and estimate your risk of breaking a bone.

Medicare Part B, which is your medical insurance, covers bone mass measurements as a preventive service. This means Medicare pays for the test to help prevent health problems before they happen. If your test is covered, you may not have to pay anything at all.

To get the scan for free, you must see a provider who accepts assignment. Accepting assignment means your doctor or clinic agrees to accept the Medicare-approved amount as full payment for the service. If your healthcare provider accepts assignment, you pay $0 for a covered bone density test.

This guide was updated in July 2026\. We’ll review the latest Medicare rates and rules for 2026, then compare them with prior years so you can see what Medicare covers and what costs may apply.

## Who Is Eligible for a Free Bone Density Scan Under Medicare?

![A doctor explaining bone health results to an older patient in a warm office](https://images.bannerbear.com/direct/4mGpW3zwpg0ZK0AxQw/requests/000/155/202/500/NgL30amMOYe10Lb7YprJxBoye/13fc99ab604821142f397d382490badb295e2459.jpg "A doctor explaining bone health results to an older patient in a warm office")

Medicare does not cover bone density scans for everyone automatically. You must meet specific clinical rules to qualify. Medicare has established five specific eligibility criteria to qualify for a covered scan. You must meet at least one of these five conditions:

- **Estrogen deficiency.** This includes women whose doctors determine they are at risk for weak bones because of estrogen deficiency. Estrogen helps regulate bone remodeling by slowing the cells that remove old bone; when estrogen drops, bone can break down faster than the body rebuilds it.
- **Spine abnormalities on imaging.** This includes individuals whose X-rays suggest vertebral abnormalities, bone loss, or possible fractures in the spine.
- **Long-term steroids.** This includes anyone taking, or planning to take, steroid-type medications such as prednisone for an extended period.
- **Primary hyperparathyroidism.** This condition happens when overactive parathyroid glands release too much hormone, pulling calcium out of the bones and into the blood, which can weaken bones.
- **Treatment monitoring.** This includes patients taking an approved osteoporosis drug who need a scan to help determine whether the treatment is working.

Medicare has a standard frequency limit for these scans. It covers routine screenings once every 24 months, which is once every two years. However, there are exceptions. Medicare will cover more frequent scans if a doctor decides they are medically necessary. For example, if you start a new steroid treatment or have a sudden change in your bone health, your doctor can order a scan sooner.

It is important to know what Medicare does not count for monitoring. Medicare does not count calcium, vitamin D, or estrogen hormone replacement therapy as approved drug therapies for the purpose of monitoring. If you are only taking these supplements, you cannot get scans more often than the 24-month limit.

Under Medicare's national coverage rules, hypogonadism alone - meaning low testosterone - is not listed as a qualifying reason for a routine free bone density screening. A man with low testosterone may still be covered if he meets another Medicare criterion, such as long-term steroid use, primary hyperparathyroidism, vertebral fracture concerns, or monitoring of osteoporosis drug therapy.

To learn more about your options, you can read about [Medicare bone health coverage](https://blog.groovehealth.com/medicare-bone-health-coverage/) or review [DEXA Medicare Part B coverage](https://blog.groovehealth.com/dexa-medicare-part-b-coverage/). You can also find out if Medicare covers your scan by visiting [Does Medicare Cover DEXA Bone Density Scans?](https://blog.groovehealth.com/does-medicare-cover-dexa-bone-density-scans/) and [DEXA Scan Frequency](https://blog.groovehealth.com/dexa-scan-frequency/). For official guidelines, you can view the [Medicare.gov bone mass measurements page](https://www.medicare.gov/coverage/bone-mass-measurements?ref=blog.groovehealth.com).

## What Are the Specific Medicare Reimbursement Rates and CPT Codes?

When clinics bill Medicare, they use standard five-digit numbers called CPT codes. CPT stands for Current Procedural Terminology. The table below compares these codes, their descriptions, and the national average Medicare reimbursement rates for 2023, 2025, and 2026.

| CPT Code  | Description                                | Billing Type      | 2023 Rate | 2025 Rate | 2026 Rate |
| --------- | ------------------------------------------ | ----------------- | --------- | --------- | --------- |
| **77080** | DEXA scan, axial skeleton (spine and hips) | Global (Office)   | $38.63    | $38.17    | $39.41    |
| **77080** | DEXA scan, axial skeleton (spine and hips) | Hospital Facility | $106.88   | $106.64   | *Varies*  |
| **77080** | DEXA scan, axial skeleton (spine and hips) | Professional Fee  | $9.49     | $9.06     | *Varies*  |
| **77078** | CT bone density, axial skeleton (spine)    | Global (Office)   | $106.74   | $97.04    | *Varies*  |
| **76977** | Ultrasound bone density, peripheral (heel) | Global (Office)   | $7.12     | $7.12     | *Varies*  |

To understand these rates, you must know the difference between "Global" billing and "Professional/Facility" billing.

A Global rate applies when you get your scan done in a freestanding doctor's office or an independent imaging clinic. This single payment covers both the use of the machine, which is the technical part, and the doctor's written report, which is the professional part.

If you get your scan done in a hospital outpatient department, the billing is split. Medicare pays a higher Facility payment to the hospital to cover the cost of the machine and the room. It then pays a smaller Professional fee to the doctor who reads and interprets your scan.

Medicare sets these rates using Relative Value Units, which measure three things: the physician's work, the practice's overhead expenses, and malpractice insurance costs. Each part is adjusted for local cost differences, added together, and multiplied by a dollar figure called the conversion factor — about $33.40 in 2026.

There is a massive markup between what Medicare pays and what clinics actually charge. While Medicare's capped rate for a standard office DEXA scan is $39.41 in 2026, the average provider charge is $218.61\. This means the average clinic charge is about five and a half times higher than what Medicare pays. If you do not have insurance or do not qualify for coverage, you could be billed this higher amount.

You can [look up the current Medicare rate for CPT 77080 in the CMS Physician Fee Schedule](https://www.cms.gov/medicare/physician-fee-schedule/search?ref=blog.groovehealth.com) to see how these costs are calculated. You can also look at the [2025 bone densitometry coding guide](https://www.hologic.com/sites/default/files/MISC-02993-REV014-Bone-Densitometry-Coding-Guide-2025.pdf?ref=blog.groovehealth.com) or the [2023 bone densitometry coding guide](https://www.hologic.com/sites/default/files/2023-01/MISC-02993-Rev012-Bone-Densitometry-Coding-Guide-2023-Jan-update.pdf?ref=blog.groovehealth.com) for more details.

## How Did Historical Policy Changes Impact Bone Density Testing?

In the past, Medicare paid much higher rates for bone density scans performed in doctors' offices. However, a law called the Deficit Reduction Act of 2005 changed this. The law took effect in 2007 and significantly cut Medicare payments for office-based imaging services, including DEXA scans.

Before these cuts, Medicare paid about $130 for an office-based DEXA scan in 2006\. In 2007, that payment was reduced to $82\. By 2013, the payment dropped even further to around $50\. These cuts only applied to doctor's offices, they did not apply to hospital outpatient departments.

Because the payments became so low, many local doctors could no longer afford to run DEXA machines in their offices. Many clinics stopped offering the scans entirely. This forced patients to travel to hospital outpatient departments to get their tests done.

This shift created barriers to care. It made it much harder for older adults to get routine scans, especially in rural areas where hospitals are far away.

Research suggests that when patients miss their follow-up scans, there are serious clinical consequences. Patients who do not get regular scans are much less likely to have their osteoporosis medications adjusted. They are also less likely to restart their treatment if they stop taking their medicine.

This matters because bone health changes over time. Doctors use these scans to monitor osteoporosis, a disease that makes bones weak and more likely to break. They also use them to monitor osteopenia, thinning bones that are weaker than normal but not yet osteoporosis. How often a scan is repeated depends on your own risk — sometimes every year or two, sometimes much less often. Without follow-up scans, bone loss can go unnoticed until a painful break occurs.

To learn more, you can [read the research on how the 2007 Medicare cuts affected bone density testing and drug therapy](https://www.dovepress.com/associations-between-the-2007-medicare-reimbursement-reduction-for-bon-peer-reviewed-fulltext-article-PPA?ref=blog.groovehealth.com). You can also learn more by reading [Understanding Osteoporosis](https://blog.groovehealth.com/understanding-osteoporosis/) or [DEXA After Fracture Medicare](https://blog.groovehealth.com/dexa-after-fracture-medicare/). For general information on bone health, visit the [International Osteoporosis Foundation](https://www.osteoporosis.foundation/patients/about-osteoporosis?ref=blog.groovehealth.com).

## Why Might Medicare Deny a Bone Density Claim and How Can You Avoid It?

Sometimes, Medicare denies claims for bone density scans, leaving patients with unexpected bills. Understanding the most common reasons for these denials can help you and your provider avoid them.

- **Scanning too frequently.** Medicare will deny a claim if you get a scan more often than once every 24 months, unless your doctor has documented a clear medical necessity for an earlier test.
- **Coding errors.** A common mistake occurs when a clinic bills for a full central DEXA scan using CPT code 77080, but they actually performed a simple heel ultrasound using CPT code 76977\. Medicare will deny the claim if the code does not match the service.
- **Missing doctor's order.** You must have a formal order from your treating doctor or healthcare provider before you get the scan. Medicare will not pay for self-referred tests.
- **Lack of proper certification.** The clinic performing the scan must be Medicare-certified and have the proper laboratory certificates.
- **Outdated technology.** Medicare explicitly bans payments for older, less accurate technologies. This includes Single Photon Absorptiometry and Dual-Photon Absorptiometry.

To ensure your claim is approved, your provider must submit the correct documentation. This includes using the highly specific ICD-10 diagnosis codes that match your medical condition. If the scan is being done to monitor your treatment, your provider must also list the name of your specific FDA-approved osteoporosis drug in Box 19 of the claim form.

You can [review the official Medicare billing and coding guidelines for bone mass measurements](https://downloads.cms.gov/medicare-coverage-database/lcd%5Fattachments/34639%5F24/L34639%5FMS004%5FBCG.pdf?ref=blog.groovehealth.com) to see the exact rules. You can also read the [National Coverage Determination for bone density studies](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=256&NCDver=2&ref=blog.groovehealth.com). To understand your results, read [How to Interpret Bone Density](https://blog.groovehealth.com/how-to-interpret-bone-density/) and [Interpreting DEXA Scan Results](https://blog.groovehealth.com/interpreting-dexa-scan-results/).

## How Can Groove Health Help You Manage Your Bone Health and Prevent Fractures?

Getting a bone density scan is an important first step, but managing your bone health requires active daily care. Groove Health is a Medicare-covered bone health program that helps older adults prevent fractures, improve bone density, and manage osteoporosis through personalized, home-based care plans.

When you join Groove Health, you work with a physician who oversees your care. A physical therapist helps design a personalized exercise plan based on your bone health, strength, balance, and goals. Your plan is built to help you load your bones safely, improve confidence with movement, and reduce fracture risk over time.

To build bone strength, you must understand how your body makes new bone. Your bones are constantly changing. Cells called osteoblasts are responsible for building new bone tissue.

These cells only start working when your bones experience a physical force. This force is called an osteogenic load, which means a load big enough to grow bone.

Research suggests that heavy resistance training is the best way to create this load. This means lifting weights that are heavy enough that you can only lift them a few times before needing a rest.

Many people believe that light weights, high-rep circuits, or light resistance bands will build bone. While these exercises are good for building muscle and improving mobility, they do not create enough load to build bone strength. They can help beginners prepare for heavier work, but they should not be the main focus of your bone-building plan.

Similarly, walking is excellent for your heart and general health, but walking alone does not provide enough load to strengthen your bones.

To strengthen your hips and spine, you must do exercises that target those specific areas. Groove Health focuses on large compound movements, such as:

- **Squats** to strengthen your hips and thighs.
- **Lunges** to build lower-body strength and stability.
- **Hip hinges**, such as a Romanian deadlift, which is a move where you bend at the hips, not the waist, to lift a weight. When doing this move, you must keep your back long and straight, not rounded.

Spinal extension, which means gently arching or straightening your back, is safe and highly encouraged because it strengthens your back muscles. However, you must avoid loaded spinal flexion, which means rounding your back forward while holding a weight. This forward rounding can increase the risk of a spine fracture.

Your plan should also include power training. Power means using strength quickly, so your body can react fast when you need it. It tends to decline with age, but it is one of the key skills that helps you recover your balance if you trip or stumble.

Preventing falls is one of the most important ways to protect your bones. The CDC reports that falls cause more than 95% of hip fractures, usually by falling sideways. You can learn more about this on the [CDC fall prevention page](https://www.cdc.gov/falls/about/index.html?ref=blog.groovehealth.com).

Balance is a trainable skill that can lower your risk of falling. A good program progresses through two types of balance:

- **Static balance**, which means holding steady in one place, such as standing on one leg. This is the best starting point for beginners.
- **Dynamic balance**, which means staying steady while you are moving, such as stepping or reaching. This challenges your balance the way real life does.

Groove Health's personalized plans safely guide you through these exercises, starting at your current ability and helping you progress over time.

You can [visit the Groove Health homepage](https://www.groovehealth.com/?ref=blog.groovehealth.com) or [check your eligibility for the Groove Health program](https://my.groovehealth.com/signup/osteo/start?ref=blog.groovehealth.com).

To learn more about bone health terms, read [T-Score Below -2.5 Meaning](https://blog.groovehealth.com/t-score-below-25-meaning/), view the [T-Score Osteopenia Range Chart](https://blog.groovehealth.com/t-score-osteopenia-range-chart/), or read a [T-Score Meaning Explained Simply](https://blog.groovehealth.com/t-score-meaning-explained-simply/). You can also learn about your [DEXA T-Score Fracture Risk](https://blog.groovehealth.com/dexa-t-score-fracture-risk/), find out [When to Start Osteoporosis Treatment](https://blog.groovehealth.com/when-start-osteoporosis-treatment/), or read about the [Fracture Liaison Service Osteoporosis](https://blog.groovehealth.com/fracture-liaison-service-osteoporosis/).

## Frequently Asked Questions About Medicare Bone Density Reimbursement

### How much will I pay out-of-pocket for a DEXA scan if I have Medicare?

If you meet Medicare's eligibility rules and your provider accepts Medicare assignment, you will pay $0\. If you do not meet the criteria, or if you get scanned more often than once every two years without a doctor's medical justification, you may have to pay the full cost of the scan. In 2026, the Medicare-approved rate is $39.41, but clinics that do not accept Medicare may charge an average of $218.61.

### What is the difference between a central DEXA scan and a peripheral bone test?

A central DEXA scan uses CPT code 77080 and measures bone strength in your hip and spine. These are the most common places for serious bone breaks, and this scan is the clinical gold standard. Peripheral tests, such as a heel ultrasound using CPT code 76977, measure smaller bones in your wrist, fingers, or heel. While Medicare covers peripheral tests, they are only used for initial screenings and cannot be used to monitor how well your osteoporosis medication is working.

### Does Medicare cover bone density scans for men?

Yes, Medicare covers bone density scans for men, but they must meet specific high-risk criteria. These criteria include taking long-term steroid medications, having primary hyperparathyroidism, or being monitored for osteoporosis drug therapy. Medicare does not cover routine screenings for men based on testosterone deficiency alone, even though low testosterone is linked to bone loss.

## What Are the Key Takeaways for Patients and Providers?

Medicare Part B fully covers bone density scans once every 24 months for eligible individuals, as long as the provider accepts assignment. This means most older adults can get this important screening at no cost.

However, patients and providers must work together to avoid unexpected bills. Always verify whether your scan will be performed in a doctor's office or a hospital outpatient department, as this changes how the service is billed. Keeping track of your previous scan dates and ensuring your doctor uses the correct diagnosis codes will prevent claim denials.

A bone density scan tells you where you stand. The next step is knowing what to do with that information. Groove Health can help turn your results into a clear plan. Groove Health offers a Medicare-covered bone health program for older adults that supports fracture prevention, bone strength, balance, and osteoporosis management through personalized care at home. Each member works with a physician, and a physical therapist designs a customized exercise plan, so you can progress safely and build confidence without having to figure it out alone.

## Works Cited

1. Centers for Medicare & Medicaid Services. [NCD - Bone (Mineral) Density Studies (150.3)](https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=256&NCDver=2&ref=blog.groovehealth.com). *CMS Medicare Coverage Database*, 2024.
2. Medicare.gov. [Bone mass measurements](https://www.medicare.gov/coverage/bone-mass-measurements?ref=blog.groovehealth.com). *U.S. Centers for Medicare & Medicaid Services*, 2026.
3. Centers for Medicare & Medicaid Services. [Search the Physician Fee Schedule](https://www.cms.gov/medicare/physician-fee-schedule/search?ref=blog.groovehealth.com). *CMS Physician Fee Schedule Look-Up Tool*, 2026.
4. Kim SJ, Lee JH, Kim S, Nakagawa S. [Associations between the 2007 Medicare reimbursement reduction for bone mineral density testing and osteoporosis drug therapy patterns](https://pubmed.ncbi.nlm.nih.gov/25028539/?ref=blog.groovehealth.com). *Patient Preference and Adherence*, 2014;8:1053-1060.

*This content is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare professional for diagnosis and treatment. If you are on Medicare and interested in a personalized bone health program, you can check your eligibility at groovehealth.com.*