DEXA Scans: What You Need to Know

A dual-energy X-ray absorptiometry (DEXA) scan, or a bone density test, is a tool for assessing bone health and diagnosing conditions like osteoporosis.

❕Knowing when and why a DEXA scan is recommended, how insurance covers it, and what coding is involved can help you navigate this essential diagnostic procedure.

💬 What Is a DEXA Scan?

A DEXA scan measures bone mineral density (BMD) to evaluate bone strength and assess the risk of fractures. This non-invasive procedure uses two low-dose X-ray beams to calculate the density of bones in key areas such as the spine, hip, and forearm.

Why Is a DEXA Scan Done?

DEXA scans are used to:

• Diagnose osteoporosis or osteopenia (low bone density)
• Assess fracture risk, particularly in older adults
• Monitor the effectiveness of osteoporosis treatment
• Evaluate bone health in patients with risk factors such as long-term steroid use, smoking, or certain medical conditions (e.g., rheumatoid arthritis)

🧑‍⚕️ Who Should Have a DEXA Scan?

The U.S. Preventive Services Task Force (USPSTF) recommends routine DEXA scans for:

• Women aged 65 and older
• Postmenopausal women under 65 with additional risk factors for osteoporosis
• Men aged 70 and older, though recommendations vary

Your healthcare provider may also recommend a DEXA scan if you have:

• A family history of osteoporosis or fractures
• Medical conditions or medications that weaken bones
• Early menopause or low body weight

📄 Coverage Under the Affordable Care Act (ACA)

DEXA scans may qualify for coverage as a preventive service for certain individuals at risk of osteoporosis under the Affordable Care Act (ACA). However, coverage varies widely among insurance plans.

Key Coverage Details:

• Preventive Coverage: DEXA scans are often covered without cost-sharing under the ACA for eligible individuals (e.g., women over 65 or postmenopausal women with risk factors)
• Diagnostic Coverage: If the scan is ordered due to symptoms or medical conditions, it may be classified as diagnostic and subject to deductibles, copays, or coinsurance
• Frequency of Coverage: Many plans limit how often DEXA scans can be performed (e.g., once every 1-2 years)

🩺 Preventive vs. Diagnostic DEXA Scans

• Preventive DEXA: Recommended as part of routine screening for osteoporosis in asymptomatic individuals at high risk. Covered at no cost under ACA guidelines when performed in-network for eligible individuals.
• Diagnostic DEXA: Performed to investigate specific symptoms, fractures, or underlying conditions. Diagnostic scans may have associated out-of-pocket costs, depending on your insurance plan.

✅ The Importance of Receiving Care In-Network

Receiving your DEXA scan at an in-network facility allows you to maximize insurance benefits and minimize costs.

• Unexpected Out-of-Pocket Costs: Out-of-network services are not typically covered as preventive, resulting in significant out-of-pocket expenses.
• Balance Billing: Some out-of-network providers may charge you for the difference between their fees and what your insurance plan reimburses.

❕Note: Always confirm network status with your insurer and the facility before scheduling your appointment.

✍️ CPT and Diagnosis Codes for DEXA Scans

Below are commonly used CPT and ICD-10 codes for DEXA scans:

CPT Codes

• 77080: DXA bone density study, one or more sites (e.g., spine, hip)
• 77081: DXA peripheral (e.g., wrist, heel)
• 77085: DXA bone density study with vertebral fracture assessment (VFA)

ICD-10 Diagnosis Codes

• Z13.820: Screening for osteoporosis
• M81.0: Age-related osteoporosis without current pathological fracture
• M85.80: Other specified disorders of bone density and structure, unspecified site

❕Note: This is not an exhaustive list of codes.

Prioritize your health, stay informed, and don’t hesitate to discuss any concerns with your provider. Strong bones support an active, fulfilling life - take steps today to protect them for tomorrow.

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