From the Guidelines
Insurance typically covers DEXA scans for women aged 65 and older and men aged 70 and older as part of routine screening, as well as for younger individuals with specific risk factors, as deemed medically necessary. According to the most recent guidelines, including the 2022 update from the Journal of the American College of Radiology 1, and the 2025 recommendation statement from JAMA 1, DEXA scans are recommended for routine screening in older adults. The American College of Obstetricians and Gynecologists guidelines also recommend BMD screening with DXA beginning at age 65 years in all women and selective screening with BMD in women younger than 65 years who have an elevated risk of osteoporosis based on a formal clinical risk assessment tool 1.
Key Points to Consider
- Insurance coverage for DEXA scans often extends to those with a family history of osteoporosis or those who have experienced early menopause.
- Most plans cover DEXA scans every two years, though more frequent testing may be covered if medically justified.
- To ensure coverage, patients should obtain a referral from their healthcare provider and verify with their insurance company beforehand, as coverage policies vary between insurers.
- Some plans may require prior authorization or have specific coverage limitations, and patients may be responsible for copays or deductibles depending on their specific insurance plan.
Risk Factors for Consideration
- Low body weight
- Previous fractures
- Use of certain medications (like long-term steroids)
- Rheumatoid arthritis
- Conditions that cause bone loss
- Family history of osteoporosis
- Early menopause
It is essential to note that while older studies, such as the 2013 practice bulletin from the American College of Obstetricians and Gynecologists 1, provide valuable insights, the most recent and highest-quality studies, including those from 2022 1 and 2025 1, should be prioritized when making decisions about insurance coverage for DEXA scans.
From the Research
Insurance Coverage for DEXA Scans
- Insurance coverage for DEXA scans typically applies to patients who have an increased risk of fracture based on clinical risk factors 2.
- The diagnosis of osteoporosis can be confirmed by DEXA, and insurance may cover this test if the 10-year risk of major osteoporotic fracture is > 10% 2.
- DEXA scans are useful in determining if bone protective treatment is needed immediately or if it could be delayed until the T score falls below -1.5, especially in younger individuals 2.
- Insurance may cover DEXA scans for patients with a history of fragility fractures, osteopenic BMD, or those who are at least 50 years old with a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture 3.
Conditions for Insurance Coverage
- Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD may be eligible for insurance coverage for DEXA scans 3.
- Insurance coverage may also apply to patients who are being monitored regularly to track expected gains in BMD by serial DEXA scans while being treated for osteoporosis 3.
- However, the specific conditions for insurance coverage may vary depending on the insurance provider and the patient's individual circumstances.
Related Studies
- A study published in 2007 discussed the role of DXA bone density scans in the diagnosis and treatment of osteoporosis, highlighting its importance in evaluating individuals at risk of osteoporosis 4.
- Another study published in 2021 explored the correlation between HU values measured from CT images and BMD calculated from DEXA scans, suggesting that CT scans can provide information about a patient's bone density 5.