Does Medicare Cover Bone Density Tests?
You may be at a higher risk for having lower than normal bone density if you are a woman over the age of 65 or a man older than 70. Other common risk factors include the following conditions:
- Having had a previous bone fracture that was caused by a minor incident.
- Rheumatoid arthritis
- Low body weight
- Vertebral abnormalities
- Primary hyperparathyroidism
- A history of eating disorders
If you have any of these conditions, or if your body type, age, or gender puts you at a higher risk for reduced bone density, your health care provider might order a bone density exam. These tests are non-evasive, and the most common type of bone density exam is a dual-energy X-ray absorptiometry (DXA or DEXA) scan.
A DXA scan typically measures bone density in the spine, hip, and wrist. Your health care provider looks at the result of your scan and compares it to an average index based on your body measurements, age, and gender. This comparison gives your physician an idea of your risk factor for fractures, whether you have osteoporosis, or at what stage your osteoporosis is in so she can prescribe any necessary treatment.
Fortunately, Medicare covers bone density scans as preventive screening exams every two years if you meet the eligibility requirements. This article tells you about those requirements and what the coverage includes.
Does Medicare cover bone density tests?
If you have Original Medicare Parts A (hospital insurance) and B (medical insurance), your Part B benefits cover a bone mass measurement scan one time every 24 months or more often if your physician certifies that it is medically necessary. To be eligible for this coverage you must meet at least one of the following conditions:
- You are a woman, and your health care provider finds that you’re estrogen-deficient and you are at risk for osteoporosis based on your medical history and other medical issues.
- X-rays show that you possibly have osteoporosis, osteopenia, or fractures of the vertebrae.
- You take prednisone or other steroid drugs, or you are planning to begin these drugs.
- Your physician has diagnosed you with primary hyperparathyroidism.
- You are taking osteoporosis drug therapy and need scans to monitor its efficacy.
Because Medicare categorizes bone mass measurement exams as preventive care services, Original Medicare Part B pays 100 percent of the cost of the test. However, the examining physician or health care provider must accept Medicare assignment for you to get 100 percent coverage.
If you have a Medicare Advantage (Part C) plan, your provider must cover the same preventive care services that Original Medicare Parts A and B do, but many plans offer additional benefits.
Depending on the type of Medicare Advantage plan you have, you may be required to use health care providers, physicians, medical facilities, hospitals, and medical suppliers that are listed on your plan’s network of approved providers. You may also be required to get a referral from your primary care provider to see a specialist. If you aren’t sure about your plan’s restrictions for coverage, make sure to ask a plan representative for clarification before you make any appointments.