Does Medicare Cover Bone Density Tests – Overview
A bone density test is a diagnostic imaging technique that measures bone strength using minute amounts of ionizing radiation and an X-ray machine.
It is also called DEXA (dual-energy X-ray absorptiometry). Doctors use this test to check the level of minerals, such as calcium, in bones.
Doctors usually advise undergoing bone density tests when a person suffers from broken bones, fractures, and osteoporosis. Medicare covers a bone density test once every 24 months (or more frequently if medically necessary) for certain individuals at risk for osteoporosis.
Let’s examine in detail how extensively Medicare covers bone density tests and how much you may have to pay out of your own pocket.
Does Medicare Cover Bone Density Tests
Medicare Part B covers regular preventive and outpatient services. These services usually include any test your doctor prescribes to diagnose or check certain health conditions.
Bone density tests are usually done using an imaging diagnostic technique similar to a conventional X-ray.
This imaging scan provides doctors with accurate information regarding the health and strength of your bones.
Do Medicare Cover Bone Density Tests – Overview
Several different types of bone density tests are performed today. The bone density material test is the most popular one.
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:
- Being a woman determined by a doctor to be estrogen-deficient
- At risk for osteoporosis
- Individuals with vertebral abnormalities
- Individuals receiving (or expecting to receive) prednisone or steroid-type drugs
- Individuals diagnosed with primary hyperparathyroidism
- Individuals being monitored to assess the effectiveness of an osteoporosis drug treatment
Bone density tests can be performed in various approved settings, including:
- A hospital outpatient department
- A radiology center
- In some medical offices, as long as the facility is Medicare-approved and the test is ordered by a physician as medically necessary
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 that you require more frequent bone density testing.
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 covers hospital inpatient stays, including the costs associated with tests performed during the stay. However, Medicare Part B typically covers bone density tests as outpatient procedures.
You will have a deductible of $1,556 per benefit period. In addition to the deductible, you will not have to bear any coinsurance costs during the first two months of your hospital stay.
Medicare Part B
Medicare Part B covers bone density tests once every 24 months for eligible individuals. After the Part B deductible has been met, Medicare covers 80% of the Medicare-approved amount, and the patient is responsible for the remaining 20%.
Medicare may cover bone density tests more frequently than every 24 months if medically necessary, based on a healthcare provider’s judgment and specific patient needs.
If you meet these criteria and your healthcare provider is part of Medicare, you can expect the bone density scan to be performed at no cost.
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. Medicare Part C (Medicare Advantage) plans must cover at least the same benefits as Original Medicare Parts A and B. Still, they may also offer additional benefits and have different cost-sharing structures, potentially affecting out-of-pocket costs for services like bone density tests.
Conclusion
Medicare covers the cost of a bone density test every two years. If you require testing more frequently, your doctor can facilitate this by providing sufficient documented proof.
Remember, you might undergo bone density tests within a specific network to get Medicare benefits.
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