Does Medicare Cover a REMS Scan? Costs, Claims, and DXA Alternatives

Medicare does not cover a REMS scan. The procedure carries a Category III CPT code (0815T) that took effect January 1, 2024, and Medicare has not assigned it a payment rate, so claims are not reimbursed under standard Medicare rules.¹² Patients who want the scan should expect to pay out of pocket, typically $200 to $400 depending on the provider.³⁴

Why Medicare Won’t Pay for a REMS Scan

The obstacle is billing classification. The “T” suffix on CPT code 0815T marks it as a Category III code, a temporary designation used for emerging technologies. Medicare has not assigned a Relative Value Unit to the code, which means there is no established reimbursement rate.²

Category III codes are not automatically covered. Whether Medicare will pay depends on the local Medicare Administrative Contractor (MAC) issuing a Local Coverage Determination (LCD) that classifies the service as reasonable and necessary. Submitting a Category III code that is not listed in an LCD or other coverage document is effectively treated as a request for a denial.⁵ No MAC has issued an LCD covering 0815T for REMS bone density assessment.

By contrast, Medicare Part B does cover bone density measurements performed with several established methods, and those procedures have their own CPT and HCPCS codes: DXA of the axial and appendicular skeleton (77080, 77081, 77085), peripheral ultrasound bone density measurement (76977), CT bone mineral density study (77078), and single-energy X-ray absorptiometry (G0130).⁶ Code 0815T is not on that list.

What Medicare Does Cover for Bone Density Testing

Medicare Part B covers bone mass measurements as a preventive benefit with no copayment, coinsurance, or deductible when the provider accepts assignment. You qualify if you meet at least one of these conditions:⁷

You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis.
Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
You take or plan to begin prednisone or steroid-type drugs (generally more than three months).
You have a confirmed diagnosis of primary hyperparathyroidism.
Your doctor is monitoring whether osteoporosis drug therapy is working.

The standard frequency is once every 24 months, more often if medically necessary. These rules apply only to the covered procedure codes above. Because REMS has no covered code, the eligibility and frequency rules don’t open a path to payment for it.

FDA Cleared, But Not Covered

The Echolight EchoS device that performs REMS scans is FDA-cleared. It received an initial 510(k) clearance in 2018, with updated indications cleared in 2021 under submission K202514. The FDA classified it as a Class II bone sonometer, finding it substantially equivalent to earlier ultrasound bone density devices.⁸

FDA clearance does not equal Medicare coverage. Payment requires an established billing pathway, typically a Category I CPT code with an assigned rate, or inclusion in a coverage determination. REMS has neither.

Marketing language sometimes blurs this line. Echolight’s website states that REMS can be used for “over six hundred disorders listed in Medicare coverage policies for which a bone density study is required.”¹ Patient accounts describe a different reality. In online discussions, patients have reported that REMS providers such as Screen My Bones do not accept Medicare and will not supply the paperwork needed to file for reimbursement, and no patients in those threads reported successfully obtaining Medicare payment for a REMS scan.⁹

In theory, NCD 150.3 (the national policy on bone density studies) does not exhaustively list approved technologies, and CMS has noted that when an NCD does not specifically exclude a service, a MAC may cover it at its discretion through an LCD.¹⁰ In practice, none has done so for REMS.

What You’ll Pay and How to Cover It

Out-of-Pocket Cost

Without insurance, the typical charge is $200 to $400. One national provider lists individual scans at $279; other clinics charge $300 to $400.³⁴ Some facilities have offered promotional pricing as low as $150 during health awareness events.¹¹ Payment is generally due at the time of service.

HSA and FSA Funds

If you have a Health Savings Account or Flexible Spending Account, bone density assessments generally qualify as eligible medical expenses, letting you pay with pre-tax dollars.¹² Eligibility depends on the plan administrator, and services used purely for general wellness rather than diagnosing or monitoring a condition may not qualify. Ask your plan what it requires, and ask your provider for a letter of medical necessity if needed.¹³

Filing Your Own Medicare Claim

If a provider won’t bill Medicare, patients on Original Medicare can technically submit their own claim using the Patient Request for Medical Payment form (CMS-1490S), along with an itemized bill and a letter explaining the request. The form goes to the MAC for your state, and claims must be filed within 12 months of the service date.¹⁴ Because 0815T has no assigned rate and appears in no coverage determination, a self-filed claim for a REMS scan will almost certainly be denied. No documented successful Medicare reimbursements for REMS have been reported.⁹

You May Still Need a DXA Scan

DXA remains the clinical standard recognized by Medicare and major medical guidelines, and most physicians base osteoporosis treatment decisions on DXA results. Even if you pay for a REMS scan, your doctor may still order a DXA for treatment decisions or insurance documentation, which Medicare will cover under the rules above if you meet the eligibility criteria.⁴

1
Echolight Medical. CPT REMS USA
2
Echolight Medical. Reimbursement Guide REMS USA
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Body Analytics. Pricing
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MelioGuide. REMS Bone Scan
5
CMS. Billing and Coding: Category III Codes
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Palmetto GBA. Bone Mass Measurements Coverage
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Medicare.gov. Bone Mass Measurements
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FDA. 510(k) Summary, EchoS Family K202514
9
Mayo Clinic Connect. REM Ultrasound for Eval of Bone Health
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CMS. NCD 150.3 Bone Mineral Density Studies
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Mobile Bone Scan Center. Echolight Scan Cost
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Precision Bone Imaging. Bone Density Scan Cost and Insurance
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OsteoSmart Health. Using HSA or FSA
14
Medicare.gov. Claims