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Does Medicare Cover Bone Density Tests?

Does Medicare Cover Bone Density Testing?

Yes, Medicare does cover bone density testing if the procedure is deemed medically necessary and completed at a Medicare-approved facility. In general, eligible beneficiaries can receive full coverage for this test once every 24 months.

Medicare pays for bone density testing for people with risk factors for osteoporosis, such as age, gender, or medical history. This includes estrogen-deficient women, people taking steroids, and people being monitored for osteoporosis. Some may be approved for additional testing.

If you meet the criteria and go to a Medicare-approved provider, you won’t pay anything for this test. Medicare Part B provides full coverage for this preventative scan. However, you might not receive coverage if the test isn’t considered “medically necessary,” if you have more frequent scans, or if the provider doesn’t accept assignment. 

What Is Bone Density Testing?

Bone density testing measures the strength and thickness of a patient’s bones. This test, also called a DEXA scan, uses X-rays to measure the amount and density of minerals, like calcium, within segments of the bones. Doctors use bone mass measurements to monitor signs of bone loss and osteoporosis, a progressive disease that causes bones to become brittle and more likely to break.

To get this measurement, health providers take X-ray images of certain sections of bones, most commonly the hip, spine, and forearm. The low-risk, non-invasive procedure takes less than 20 minutes to complete. 

If your doctor determines signs of bone loss, they may ask you to take action to prevent further damage. This could include:

  • Increasing your intake of calcium and vitamin D through diet or supplements
  • Getting more exercise, especially weight-bearing activities
  • Taking medication to preserve or increase bone density

Knowing your risk for osteoporosis and limiting bone loss is crucial. Osteoporosis is referred to as a “silent disease” because many people don’t know they have it until they break a bone.

How Common Is Osteoporosis?

Osteoporosis is fairly common among adults over 50. About 20% of women and 5% of men over 50 have osteoporosis, but there are no symptoms during the early stages of bone loss. That’s why doctors recommend regular screenings for people with risk factors related to their age or family medical history.

People with osteoporosis have a higher chance of breaking a bone, even without falling. Brittle bones could break during routine activities, such as coughing or bending over. Hip and vertebral fractures are especially worrisome for aging individuals who want to maintain their independence. While this disease isn’t curable, early detection can help slow its progress.

How Does Medicare Coverage of Bone Density Testing Work?

Thankfully, Medicare understands the risk to older adults and considers bone density tests as preventative care. Eligible beneficiaries receive full coverage for DEXA scans.

Eligibility Requirements

To get a bone density test covered by Medicare, you must meet one or more of the following requirements:

  • Your previous X-rays show signs of vertebral fractures, osteopenia, or osteoporosis.
  • You’ve been diagnosed with primary hyperparathyroidism.
  • You’re being monitored for osteoporosis treatment efficacy.
  • You have an estrogen deficiency.
  • You take or plan to take steroid-type drugs, like prednisone.

It also must be 23 months since your last bone density scan unless you’ve been approved for more frequent testing. With Original Medicare, you won’t pay anything for this procedure as long as your provider accepts assignment.

Bone Density Testing With Medigap

Medigap beneficiaries may receive help paying for bone density scans not covered by Original Medicare. If, for example, an individual doesn’t meet the eligibility requirements or wants to be tested more frequently, Medigap might help cover out-of-pocket costs for additional scans Original Medicare may not pay for.

In addition, Medigap may make it more convenient to receive a bone density test if Medicare will not pay. Supplemental plans don’t require a referral to a specialist.

Bone Density Testing With Medicare Advantage

Medicare Advantage plans offer at least the same amount of coverage for bone density testing as Original Medicare. In some cases, you may receive coverage for additional testing or scans outside of Original Medicare’s eligibility requirements. If you have a Medicare Advantage plan, contact your insurer to clarify your policy.

Which Medicare Part Covers Bone Density Testing?

Medicare Part B covers bone density scans. While Part A covers hospital, hospice, and home health care, Part B covers preventative and medically necessary outpatient services. Preventative services include exams, vaccinations, screenings, and lab tests.

Taking advantage of preventative care helps you detect, prevent, or manage certain diseases that may worsen if not addressed. This is especially important for older adults who have a higher risk of developing severe illnesses and diseases. Monitoring bone loss, for example, allows individuals to take action sooner to lower their chances of serious injury or hospitalization and the associated medical costs. 

How Is Bone Density Testing Performed?

Bone density testing involves a non-invasive scan that typically takes 10 minutes. During the test, which usually occurs at a radiologist’s office, a patient lies on a table while two scanning machines pass above and below them. The scanners send low-dose X-rays to the bones and soft tissues in the hip and spine to determine how many minerals are packed into sections of the bone.

If your scan shows low bone density, your doctor may recommend actions to improve your bone health. If caught early enough, you may focus on lifestyle adjustments, like exercising more, quitting smoking, or eating a healthier diet. In more severe cases, medication can help slow or reverse bone loss. You can also take steps to prevent a fall, such as using a cane or installing shower handles.

By monitoring your bone density, reported as a T score and Z score, you can make educated decisions to preserve your health and independence as long as possible.

T Scores

Bone density scores are reported as standard deviations from the mean. A T score compares your bone mass measurement to a healthy 30-year-old of the same sex, which would be a score of 0. Every standard deviation indicates a 10-12% difference in bone mass; a “normal” range is -1 and above. Someone with a score from -1 to -2.5 has low bone density, while -2.5 or lower shows osteoporosis. 

Z Scores

A Z score compares your bone density to other individuals of the same age and sex. In this case, a score of 0 means your bones are precisely as strong as the average for your demographic. This context is useful when determining if you are losing bone mass quicker than similar individuals.

Bone Density Testing Vs. Bone Scans

Bone density tests differ from bone scans in both procedure and purpose. DEXA tests specifically identify signs of osteoporosis by evaluating the minerals within your bones. On the other hand, bone scans can help detect fractures, infections, cancer, arthritis, or other small irregularities that a regular X-ray might not pick up on. 

During a bone scan, a patient is injected with a small amount of radiation. After a few hours, the patient lies on a table that slides under a scanning machine. The machine traces the radioactive material collected within the bones. This allows the technician to detect abnormalities. 

Both tests identify potential bone health issues, but does Medicare cover DEXA scans and bone scans the same way? Generally, no: Since a bone scan isn’t considered preventive care, it has a different level of coverage. Patients may be responsible for a 20% copayment for diagnostic tests after their Part B deductible

How Much Does Bone Density Testing Cost?

On the other hand, for eligible beneficiaries with Original Medicare, bone density tests won’t cost anything. Without insurance, however, the scan costs between $150 and $250, depending on the facility. If you choose to have bone density testing performed without meeting one of the criteria or at a non-Medicare-approved facility, you may be responsible for some or all of the cost.

How To Get Bone Density Testing Covered By Medicare

If you’d like to get a bone density test, follow these steps to ensure Medicare fully covers the scan, and you aren’t hit with a surprise bill. 

  1. Meet with your doctor: The test must be deemed “medically necessary” to be covered by Medicare. Patients should discuss their risk and eligibility with a primary care provider or at an annual well-woman visit. The test typically requires a doctor’s referral.
  2. Choose a Medicare-approved facility: If you choose the location of the test, make sure it’s been approved by Medicare and that the provider accepts assignment or the Medicare-approved cost of a service. You can search for approved radiology offices on Medicare’s website or call the facility to confirm coverage.
  3. Present your Medicare card to the provider: When you arrive for the test, have your ID, Medicare card, and referral ready. The provider will send your claim directly to Medicare, so you shouldn’t have to pay anything upfront.

After receiving your test, you should see the service and full coverage reflected in your quarterly Medicare statement. 

Bone Density Testing At Health Fairs

Health fairs offer a quick and accessible way to test bone health. While these tests increase awareness of the risks associated with bone loss, they aren’t as reliable as a full scan. The portable machine scans a much smaller section of bone, such as a finger or heel. Bone density can change between different body parts, however, so this result may not accurately reflect your overall bone health. If the provider notices any issues, they’ll likely recommend getting a full scan. 

Bone Density Testing and You

Bone density testing is one of the most important ways to catch and prevent damage from bone loss. Since bone loss has no external symptoms during its early stage, it’s crucial to take preventative action before it becomes severe. Detecting bone loss early leaves time to change your lifestyle, habits, or medications to decrease your chances of being injured from a fall.

If you have certain risk factors for osteoporosis, including certain diseases and medications, be proactive about your bone health. Take advantage of Medicare’s preventative care coverage and go in for a scan every 24 months. In the meantime, take care of your bones by exercising, eating a nutritious diet, limiting alcohol, and avoiding cigarettes.

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