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Dual-energy X-ray Absorptiometry denials: what the review data shows
Independent reviewers have decided 15 published cases where an insurer denied Dual-energy X-ray Absorptiometry — and they overturned the insurer 60% of the time. A denial for Dual-energy X-ray Absorptiometry is a starting position, not a final answer.
Published decisions
15
2001–2026
Overturned
60%
9 denials reversed
Conditions behind dual-energy x-ray absorptiometry denials
What insurers denied — and how those fights ended.
| Category | Decisions | Overturned |
|---|---|---|
| Osteoporosis | 6 | 83.3% |
| Osteopenia | 3 | 33.3% |
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 8 | 75% |
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 7 | 42.9% |
Typical time to a decision
21 days
Most land between 16 and 23 days
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Nature of Statutory Criteria/Case Summary: An enrollee has requested reimbursement for a dual-energy X-ray absorptiometry (DXA) bone density study (CPT 77085).Findings: Three out of three physician reviewers found that the services at issue were likely to have been more beneficial than any other available standard treatments for the enrollee’s medical condition.The American College of Radiology (ACR) has established Appropriateness Criteria to help guide referring practitioners in their most efficient and efficacious use of imaging for various clinical presentations. In their guidelines for osteoporosis screening or initial imaging of clinically suspected low bone mineral density (Variant 1), a DEXA scan is identified as a first line study and assigned the Appropriateness Category of “Usually Appropriate”.
Nature of Statutory Criteria/Case Summary: The patient is a 59-year-old female with a history of osteoporosis. Findings: The physician reviewer found that bone densitometry of the hip and lumbar spine revealed a hip T-score of -2.2 and lumbar spine T-score of -2.8. The bone mineral density of the left hip was noted to be osteopenic, and the bone mineral density of the lumbar spine was noted to be osteoporotic. In a letter, the patient’s provider noted a bone density test in 2017 revealed osteoporosis of the lumbar spine, and the left hip was osteopenic. The patient had previously been treated with Evista. She has requested authorization and coverage for a bone density test (dual energy x-ray absorptiometry, also called DEXA scan). The Health Plan denied the request and reported that the requested services are not medically necessary for the evaluation of this patient.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
A 51-year-old female has requested coverage for a bone density scan/dual energy x-ray absorptiometry (DEXA) scan for evaluation of her bone pain. Findings: The physician reviewer found that the record provided for review does not establish that this patient is at risk for osteoporosis. Pain alone is not an indication of osteoporosis or bone loss. The patient is 51-years-old and there is no documentation that she is in menopause or has any other form of estrogen deficiency. Her comprehensive metabolic panel, including calcium, kidney function, and complete blood count (CBC) are all normal. The patient has diabetes but this is reportedly well controlled. In addition, the patient has no history of fractures or history of glucocorticoid use.
A 51-year-old female has requested coverage for a bone density scan/dual energy x-ray absorptiometry (DEXA) scan for evaluation of her bone pain. Findings: The physician reviewer found that the record provided for review does not establish that this patient is at risk for osteoporosis. Pain alone is not an indication of osteoporosis or bone loss. The patient is 51-years-old and there is no documentation that she is in menopause or has any other form of estrogen deficiency. Her comprehensive metabolic panel, including calcium, kidney function, and complete blood count (CBC) are all normal. The patient has diabetes but this is reportedly well controlled. In addition, the patient has no history of fractures or history of glucocorticoid use.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Dual-energy X-ray Absorptiometrywhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.