DEXA Bone Density Scan
CPT 77080 is a DEXA (dual-energy X-ray absorptiometry) scan of the hip and spine, the gold standard for osteoporosis screening. Medicare pays just $39.41 for this test, but providers charge an average of $218.61 (a 5.5x markup, one of the highest among routine imaging tests). Medicare covers a DEXA scan once every 2 years for women 65 and older. Many offices own their own DEXA machines, and cash-pay prices range from $50 to $150.
CPT 77080 at a Glance
- Average provider charge: $218.61
- Medicare rate: $39.41
- Typical markup: 5.5x over Medicare
- Cash-pay range: $50 to $150
- Setting: Same rate office and facility
- Common use: Osteoporosis screening
- Medicare beneficiaries: 1.5 million
- Medicare frequency: Once every 2 years (women 65+)
On this page
How the Medicare Rate Is Calculated
Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For imaging codes like 77080, the non-facility and facility Practice Expense RVUs are identical, so Medicare pays the same rate regardless of setting. At just $39.41, this is one of the lowest-cost imaging procedures on the fee schedule, which makes the 5.5x markup to average charges especially striking.
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Physician time and interpretation | 0.20 |
| Practice Expense RVU | DEXA equipment, technologist, supplies | 0.96 |
| Malpractice RVU | Professional liability insurance | 0.02 |
| Total RVU | 1.18 | |
| x $33.4009 | 2026 conversion factor | $39.41 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). The same DEXA scan pays differently depending on your location.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $40.23 | $218.61 | 5.4x |
| California (Los Angeles) | $43.93 | $218.61 | 5.0x |
| New York (Manhattan) | $44.18 | $218.61 | 4.9x |
| Florida (Fort Lauderdale) | $41.41 | $218.61 | 5.3x |
| Ohio | $37.02 | $218.61 | 5.9x |
| Mississippi | $35.65 | $218.61 | 6.1x |
| Arkansas | $35.37 | $218.61 | 6.2x |
| Alaska | $49.06 | $218.61 | 4.5x |
Rates shown use 2026 GPCIs and the $33.4009 conversion factor. For imaging codes, the Medicare physician fee is the same in office and facility settings. The average provider charge of $218.61 is the 2023 national average from CMS utilization data.
What Insured Patients Actually Pay for a DEXA Scan
Your insurer has a negotiated rate with the facility, typically 150% to 300% of the Medicare rate. For a DEXA scan, that negotiated rate is usually $60 to $120. What you owe depends on your plan:
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| ACA preventive (eligible patients, in-network) | $0 | ACA covers osteoporosis screening for women 65+ at no cost |
| Copay plan (deductible met) | $20 to $50 | Flat copay for diagnostic imaging |
| High-deductible plan (deductible NOT met) | $60 to $120 | Full negotiated rate until deductible is met |
| Medicare Part B | $0 to $7.88 | Covered once every 2 years for women 65+; 20% of $39.41 after deductible |
Should You Use Insurance or Pay Cash?
DEXA scans are one of the most affordable imaging tests when paid in cash. Many facilities offer cash-pay pricing of $50 to $150, which may be comparable to or even lower than your insurer's negotiated rate if you have a high-deductible plan.
When Cash-Pay Wins
- The facility's cash rate ($50 to $150) is close to or below your insurer's negotiated rate
- You are unlikely to meet your deductible this year
- Your last DEXA was less than 2 years ago and Medicare or insurance will deny the claim
- You want to avoid the hassle of insurance billing for a low-cost test
When Using Insurance Wins
- You qualify for ACA preventive coverage ($0 cost)
- You are close to meeting your annual deductible
- Medicare covers the scan this year (within the 2-year interval)
- You want the results documented in your insurance records for ongoing osteoporosis management
Common Billing Problems with DEXA Scans
Billed more often than every 2 years
Medicare covers DEXA scans once every 24 months for eligible patients. If your provider orders the scan before the 2-year interval has passed, Medicare (and many private insurers) will deny the claim. You may be left with the full charge. Before scheduling, ask your provider to verify when your last covered DEXA scan was performed. If you need monitoring more frequently, discuss cash-pay options with the facility.
Charged for DEXA when only a heel ultrasound was performed
A DEXA scan (CPT 77080) measures bone density at the hip and spine using low-dose X-rays. A heel ultrasound (CPT 76977) is a simpler, cheaper screening tool that only measures peripheral bone density. If you received a heel ultrasound but were billed under CPT 77080, the coding is incorrect. DEXA is the gold standard for osteoporosis diagnosis, while heel ultrasound is a screening tool only. Verify that your bill matches the test you actually received.
5.5x markup on a routine test
The 5.5x markup between Medicare's $39.41 rate and the average charge of $218.61 is one of the highest among routine imaging tests. Many offices own their own DEXA machines and bill at full charge rates. If you are paying out of pocket or have a high-deductible plan, always ask about the cash-pay price before the scan. Cash prices of $50 to $150 are widely available.
Insurance denial for patients under 65
While Medicare covers DEXA scans primarily for women 65 and older, private insurers have varying coverage criteria. Some cover the scan for postmenopausal women under 65 with risk factors, while others deny it. If your claim is denied, ask your provider to submit a letter of medical necessity citing your specific risk factors (family history, prior fractures, long-term steroid use, or low body weight).
Related Imaging Codes
| Code | Description | Medicare Rate |
|---|---|---|
| 77080 | DEXA bone density, axial (hip/spine) | $39.41 |
| 77081 | DEXA bone density, appendicular (wrist) | Lower |
| 76977 | Bone density study, ultrasound (heel) | Lower |
Frequently Asked Questions
How much does a DEXA bone density scan cost without insurance?
Without insurance, a DEXA scan (CPT 77080) costs $50 to $400 depending on the facility. The national average provider charge is $218.61. Cash-pay DEXA scans are available at many facilities for $50 to $150. Medicare pays $39.41. The 5.5x markup between Medicare and average charges is one of the highest among routine imaging tests.
How often does Medicare cover a DEXA scan?
Medicare covers a DEXA bone density scan once every 24 months (2 years) for women age 65 and older and for certain high-risk individuals. If your doctor orders it more frequently, Medicare may deny the claim and you could be responsible for the full cost. Make sure your provider checks when your last covered scan was before ordering a new one.
Why is my DEXA scan bill $200 or more when Medicare only pays $39?
The 5.5x markup on DEXA scans is one of the highest among routine tests. Many endocrinology and rheumatology offices own their own DEXA machines and bill for both the scan and the interpretation. At Medicare rates the total is under $40, but at charged rates it can reach $200 to $400. If you are paying out of pocket, ask about cash-pay pricing, which is often $50 to $150.
What is the difference between a DEXA scan and a heel ultrasound?
A DEXA scan (CPT 77080) uses low-dose X-rays to measure bone density at the hip and spine, which are the most clinically relevant sites. A heel ultrasound (CPT 76977) is a cheaper screening tool but only measures peripheral bone density and is less accurate. If you were billed for a full DEXA scan but only received a heel ultrasound, the coding may be incorrect. DEXA is the gold standard for osteoporosis diagnosis.
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