Does Medicare Cover Bone Density Tests?

Does Medicare Cover Bone Density Tests – Overview?

A bone density test is a diagnostic imaging technique. It uses minute amounts of ionizing radiation along with an X-ray machine to measure the strength of bones.

It is also called DEXA (dual-energy X-ray absorptiometry). This test is useful for doctors to check the level of minerals, such as calcium, in your bones.

Doctors usually advise undergoing bone density tests when a person suffers from broken bones, fractures, and conditions like osteoporosis. Medicare acknowledges this risk and provides insurance coverage for bone scans every alternate year.

Let’s see, in detail, how extensively Medicare covers bone density tests and how much you may have to pay out of your pockets.

Does Medicare Cover Bone Density Tests?

Regular preventive and outpatient services are covered under Medicare Part B. These services usually include any test that your doctor prescribes to diagnose or check certain health conditions.

Bone density tests are usually done using an imaging diagnostic technique that is similar to a conventional X-ray technique.

This imaging scan provides doctors with accurate information regarding the health and strength of your bones.

There are several different types of bone density tests performed today. However, the bone density material test is the most popular among these.

Medicare updated its policies and removed other similar tests from its coverage in 2007.

Medicare covers bone density tests once every 24 months. These are covered when the doctor suspects bone problems or related injuries to occur.

To qualify for Medicare coverage for bone density tests, you need to fulfill any one of the below-given conditions:

• Chronic kidney disease
• Rheumatoid arthritis
• Diabetes
• Overactive parathyroid gland and other hormonal imbalances
• Organ transplant

You can undergo bone density tests at hospitals or clinics with radiology services, such as:

• Medical office building
• Diagnostic laboratory
• Imaging center
• Outpatient facility

Other essential factors that can result in your seeking bone density test coverage from Medicare include:

• Your doctor orders a scan as a medically necessary test
• Over 23 months have passed since your last bone density test
• You are suffering from a condition that frequently needs to be tested
• You seek the scan at a Medicare-recognized facility

Getting Bone Density Test under Medicare

To ensure that you fulfill the criteria to have a bone density test under Medicare coverage, your doctor will need to provide documented proof for any of the following conditions:

• Require test for medical reasons, including high-risk osteopenia, osteoporosis, sudden injury or pain
• Currently taking osteoporosis medication and the doctor needs to check the progress
• Suffering from primary hyperthyroidism
• Having an estrogen deficiency

In addition, you can also get full Medicare coverage for bone density tests if 23 months have passed since the last scan. Exceptions are made for patients with special needs that require more frequent testing.

For this facility, you will have to provide proof from your doctor to show you require more frequent testing for bone density.

Out of Pocket Expenses for Bone Density Tests under Medicare

Let’s take a quick look at the extent of Medicare coverage for bone density tests in terms of the different types of insurance plans:

Medicare Part A

Medicare Part A usually covers bone scans if it is part of an inpatient hospital procedure at a skilled nursing facility or hospital.

You will have a deductible of US$ 1,556 per benefit period. Apart from the deductible, you will not have to bear any coinsurance costs during the first 2 months of your hospital stay.

Medicare Part B

If you are advised to undergo a bone density test by your doctor, then Medicare will cover the complete cost of the scan every 2 years.

Medicare also offers to cover the cost of bone density scans more often in case your specific medical condition requires it.

If you meet these criteria and your healthcare provider is part of Medicare, then you can expect the bone density scan to be performed at no cost to you.

Medicare Part C

Medicare Advantage, or Medicare Part C, is useful to match the coverage provided by your original Medicare Part A and B insurance plan.

However, the two plans have different criteria regarding where to test and deductibles. Usually, Medicare Part C plans may not help you save any additional costs.

Conclusion

Medicare offers to cover the cost of a bone density test every 2 years. In case you require testing more frequently, then your doctor can facilitate this by providing sufficient documented proof.

Remember, you might have to undergo bone density tests within a certain network to get Medicare benefits.

See Also

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