Saturday, June 15, 2024

Is A Bone Density Test Covered By Medicare

Don't Miss

Treatment Disparities For Men And Women

Osteoporosis and Seniors on Medicare | Important Information

Not only are men less likely to be screened for osteoporosis, they are less likely to be treated once a diagnosis is made. A 2012 study of over 17,000 men found that less than 10% of men received osteoporosis treatment, even after a fracture. They were more likely to receive treatment if they had a spinal fracture, were taking steroids or antidepressants, or were seeing a primary care physician.

There are many calcium and vitamin D supplements available over the counter but people with osteoporosis may need prescription medications. Again, men may be at a disadvantage when compared to their female counterparts.

Medicare Part D covers most prescription medications, depending on the planâs formulary. However, Part B does pay for some injectable osteoporosis medications but only for women.

Specifically, you must be a woman with a postmenopausal osteoporotic fracture, you are unable to inject the medication yourself, and you do not have family members or caregivers who will help you do it. Once your healthcare provider certifies all this to be true, Medicare will pay 20% the cost of your medication. Otherwise, you will need to turn to your Part D benefits, if you have them.

Does Medicare Pay For Bone Density Tests

So, does Medicare cover bone density tests? Bone density tests are covered under Medicare Part B, allowing eligible beneficiaries to receive a test every 24 months or more if necessary. However, you must meet one or more of the following conditions.

  • Youre a woman whose doctor determines you are estrogen-deficient and at risk for osteoporosis.
  • An x-ray youve received for another reason shows signs of osteoporosis, osteopenia, or vertebral fracture.
  • Youre taking, or planning to begin taking, prednisone or another steroid-type drug.
  • Youve been diagnosed with primary hyperparathyroidism.
  • Youre receiving drug therapy for osteoporosis.

While these tests can be expensive out-of-pocket, Medicare osteoporosis coverage can reduce your costs significantly. In fact, youll pay nothing for this test if you qualify for Medicare, though youll need to visit a provider that accepts Medicare.

However, theres a caveat: bone density tests are only considered a preventive service for individuals who can undergo menopause, meaning cisgender women and other individuals born with ovaries. If you dont fall under this category youll likely have a more challenging time getting a scan: a provider can still order it, but youll likely pay 20 percent of the cost unless you appeal to Medicare.

What To Do Next

According to the Mayo Clinic, your doctor may recommend a BMD test If you are at risk for osteoporosis or have recently suffered a fracture.5 Many Humana plans cover BMD screenings, so if you are a Humana member, your test may be covered by your plan at no additional cost to you.

Here are the next steps for scheduling your BMD test:

  • Call your doctor: Have your Humana member ID card ready when you schedule your BMD test with your doctor. If you dont have a physician, use our find a doctor tool
  • Follow your doctors advice: After the test, your doctor may create a treatment plan based on your risk for osteoporosis. Your doctor might give advice on diet, exercise or medications. They may also talk to you about ways to improve balance and prevent falls or suggest using a cane or walker.

Dont wait to call your doctor and schedule your test. Your BMD assessment is a key part of diagnosing osteoporosis, getting a treatment plan and maintaining the health of your bones.6

Preventive Care

Recommended Reading: How Much Does Medicare Cover For Nursing Home Care

What To Expect With A Bone Density Test

There is nothing you need to do to prepare for a bone density test.

When you get to the facility, you’ll likely be asked to change into a gown first. You may receive a contrast material either by mouth or through a peripheral intravenous line , which helps produce better images.

Once you’re ready, the scan will take about 10 to 30 minutes depending on the areas of the body being scanned. Typically, the hip or spine is tested, but can also be done on the radius bone in the forearm. It can depend on the facility’s equipment and your particular needs.

After your test, the doctor will view the images and use specific calculations to assign a T-score, which compares your current bone density to that of a healthy adult at age 30. The three T-score categories include:

  • Normal: -1 or higher
  • Low bone density: between -1 and -2.5
  • Osteoporosis: -2.5 and lower

What Can I Expect With A Bone Density Test

Original Medicare

You dont need to worry about any special preparation for a bone scan. You simply arrive at the testing facility wearing loose, comfortable clothing.

You may be asked to change into a hospital gown for the test. If you remain in your clothes, you should avoid metal, like zippers or lots of buttons, and remove any jewelry.

The testing center may ask you about your medical history. Be sure to tell them if you have any implanted hardware, like artificial joints or a pacemaker.

You may also receive a contrast material either by mouth or through a peripheral intravenous line to help produce better images. The entire scan should only take 10 to 30 minutes.

Don’t Miss: How To Find My Medicare Provider Number

Are Medicare Recommended Fees And Benefits Changing

There are no changes to the MBS recommended fees and benefits as part of the Taskforce recommendations. The MBS schedule fees and benefits for the two new items, 12320 & 12322, will be the same as the item they replace .

It remains the case that medical and health practitioners, including diagnostic imaging providers, are free to set their own fees for the services they provide and to determine their own billing practices. Consumers are responsible for any difference between the applicable Medicare benefit and the fee set by the provider. Where a provider chooses to bulk bill there should be no out-of-pocket cost.

How Do Bone Density Scans Help

If your doctor suspects you have osteoporosis, theyll likely prescribe a bone density test. This can take one of two forms.

  • Youll may have an x-ray taken of your spine or hip at a hospital.
  • Alternatively, a doctor or nurse may use a mobile device to take an x-ray of your finger, wrist, or heel.

The test requires no special preparation and is non-invasive. Bone density tests typically take less than 15 minutes to complete. A doctor will compare the x-ray to a healthy adult at age 30, assigning a T-score to compare your bone density. If your T-score is -2.5 or lower, youre officially diagnosed with osteoporosis. This can help reduce your risk of broken bones and fractures, but are bone density tests covered by Medicare?

You May Like: How To Apply For Medicare Without Claiming Social Security

What Happens During A Bone Density Test

Bone density testing does not require any special preparation on your part. You may be given a liquid to drink which will help produce better images of your bones for testing.

The test is done by using a small amount of ionized radiation and an X-ray machine to determine the amount of calcium and other minerals in your bones and calculate their density. Bone density testing is also called dual energy X-ray absorptiometry, or DEXA.

Several factors can lower the density of your bones, including age, sex , tobacco and alcohol use, steroid use, malnutrition, rheumatoid arthritis, bone trauma and kidney disease.

Bone Mineral Density And Anti

What to Expect: Bone Density Scan (DXA)

Wang and associates examined the effects of conventional and atypical anti-psychotics on BMD and serum prolactin levels in patients with schizophrenia. A total of 163 first-episode inpatients with schizophrenia were recruited, to whom 1 of 3 conventional anti-psychotics or 1 of 3 atypical anti-psychotics was prescribed for 12 months as appropriate BMD and PRL were tested before and after treatment. Same measures were conducted in 90 matched healthy controls. Baseline BMD of postero-anterior L1 to L4 ranged from 1.04 ± 0.17 to 1.42 ± 1.23, and there was no significant difference between the patients group and healthy control group. However, post-treatment BMD values in patients were significantly lower than that in healthy controls . The BMD values after conventional anti-psychotics were significantly lower than that after atypical anti-psychotics. The PRL level after conventional anti-psychotics was significantly higher than that after atypical anti-psychotics . Conditioned relevance analysis revealed significant negative correlations between the PRL level and the BMD values after conventional anti-psychotics. The authors concluded that the increase of PRL might be an important risk factor leading to a high prevalence of osteoporosis in patients with schizophrenia on long-term conventional anti-psychotic medication.

Don’t Miss: Who Must Enroll In Medicare

Osteoporosis And Its Complications

Osteoporosis is a medical condition characterized by architectural weakening in the bones and decreased bone mass. These changes make the bones more fragile and increase the risk of fractures, especially at the spine, hip, and wrist.

The International Osteoporosis Foundation estimates that someone has an osteoporotic fracture every three seconds, affecting a third of women and a fifth of men over their lifetimes. Debility from the condition can be significant due to decreased mobility, loss of independence, and chronic pain.

Notably, people who have hip fractures are at increased risk of dying. A 2017 study of 122,000 people found that for those who had a hip fracture, their mortality rate doubled for up to eight years afterwards.

Medicare Coverage For Bone Density Testing

Bone mass measurements are covered by Original Medicare with a doctor who deems it medically necessary, and its been at least 24 months since your last scan. Although, under certain circumstances, more frequent testing is possible.

Read through the content below to learn everything you need about Medicare coverage for bone mass testing. Well go over the different plan types and coverage you can expect. Then, well answer a few questions on bone density testing.

Read Also: What Is Medicare Plus Blue Group Ppo

Bone Density Screenings Help Diagnose Mineral Loss That Increases Your Risk Of Fractures And Other Injuries

Preventive screenings are an important part of staying healthy. These tests are performed to identify potential medical problems early, when they are easier to treat or manage. Many are covered by Medicare.

Bone density tests are a type of preventive screening that tells your doctor how strong your bones are. Covered by Medicare if you meet certain criteria, they are primarily used to diagnose osteopenia and osteoporosis. These screenings are also valuable for early detection of bone loss, so you can take steps to protect your health.

Knowing your risk for osteoporosis and whether you should get a bone density test can help ensure you get the screenings and care you need before a problem occurs. Here is more information about bone density tests, including Medicare coverage criteria, as well as more about osteoporosis and how to prevent it.

How Do Doctors Perform A Bone Density Test

Is it covered under Medicare? Check our resource here

A bone density test is also called a dual energy X-ray absorptiometry . The test is a non-invasive, painless X-ray scan of the hip and spine. A person does not need to do or wear anything special to get the test, and the entire scan typically takes 15 minutes or less.

Once a person has had a bone density test, a doctor trained in reading the scans will view the images and use calculations to assign a T-score, which compares a persons current bone density to that of a healthy adult at age 30. Three T-score categories exist:

  • normal bone density: -1 or higher
  • low bone density: between -1 and -2.5
  • osteoporosis: -2.5 and lower

In addition to receiving a T-score, a person may also receive a Z-score. This is a score that compares a persons bone density to someone of the persons similar age and size. These scores are usually more effective in identifying bone density levels in children, teenagers, and younger men and women, according to the National Osteoporosis Foundation.

Recommended Reading: Are Colostomy Bags Covered By Medicare

How Can I Make Sure I Get Full Coverage

To make sure you meet the criteria to have your bone density test fully covered by Medicare, you doctor needs to provide documentation that you meet one of the following conditions:

  • You require the test for a medical reason, such as high risk for osteoporosis, osteopenia, sudden pain, or an injury.
  • Youre taking an osteoporosis medication and your doctor needs to check your progress.
  • You have primary hyperthyroidism.
  • You have an estrogen deficiency.

Additionally, to get full coverage, make sure that it has been at least 23 months since your last scan unless you have special needs that require more frequent testing.

In this case, you must provide proof from your doctor that you have a condition requiring more frequent testing before your test will be covered again within the 2-year window.

You can always see whether any test or service is covered by checking Medicares covered services list.

How To Get Help Covering The Cost Of Bone Density Testing Under Medicare

Medicare Supplement plans fill in the gaps by covering the 20% you would otherwise pay under Part B. By relieving you of this cost, you can worry less about bills and more about recovery. The best part about a supplement is that when Medicare approves a service, the supplement must authorize the service as well. Knowing this gives many beneficiaries peace of mind.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

If you think youd benefit from supplemental coverage, give us a call. Well take the time to provide you with the information to compare as well as select the right plan. Also, if you have a plan and want to find a lower premium, contact us today! If you dont feel like calling in now, compare rates online!

  • Was this article helpful ?

Recommended Reading: Does Medicare Offer Dental And Vision Coverage

How Medicare Covers Bone Density Tests

Bone density tests help determine if you have normal bone intensity, low bone density or osteoporosis, and they are the only test that can formally diagnose osteoporosis. They can also help you find out how well an osteoporosis medication is working. Medicare covers bone density screening under Part B every 24 months as long as you meet one or more specific conditions, outlined by Medicare Advantage plans cover the same screenings without applying deductibles, copayments or coinsurance as long as you see an in-network provider and meet Medicares eligibility requirements for these services.

Getting Bone Density Test Under Medicare

Bone Density

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 cover 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.

Read Also: How To Calculate Medicare Wages

What Is Bone Density Testing

Bone density testing, which is sometimes referred to as bone densitometry or DEXA, is a type of imaging that measures how many bone minerals, including grams of calcium, are in a section of bone . A higher concentration of mineral content means denser, stronger bones, which are generally less likely to break.

Bone density testing is often used to confirm whether an individual has osteoporosis, which is indicated by fragile bones that may break easily. The test may also be helpful in determining an individuals risk of fractures and is often used to monitor a person undergoing treatment for osteoporosis.

This test may be ordered as part of a routine screening for an aging individual, or it may be recommended if youve fractured a bone, had a drop in hormone levels or experienced a significant loss of height.

Cone Beam Computed Tomography For Evaluation Of Post

Mostafa and colleagues examined the feasibility of using mandibular cone beam computed tomography radiomorphometric indices and box-counting fractal dimension to

  • detect osteoporosis in post-menopausal women,
  • compare them with the healthy control group, and
  • correlate the findings with the BMD measured by DXA.
  • osteopenia, and
  • osteoporosis groups, according to the WHO criteria.
  • Cross-sectional images were used to evaluate the CTMI, the computed tomography index ) and computed tomography index ). Student’s t test was used to compare the differences between the indices of the groups’ intraclass correlation coefficient . Statistical analysis showed a high degree of inter-observer and intra-observer agreement for all measurements . The mean values of CTMI, CTI , and CTI were lower in the osteoporosis group than in osteopenia and normal patients . In comparing normal patients and women with osteopenia, there was no statistically significant difference in the mean value of CTI . The authors concluded that quantitative CBCT indices may help dentists to screen for women with low spinal and femoral BMD so that they can refer post-menopausal women for bone densitometry.

    Also Check: Can You Change Your Medicare Supplement Insurance Anytime

    How Is Bone Density Testing Done

    Bone density testing is typically done in a clinical setting such as a hospital or an outpatient facility. After putting on a loose gown, youll be asked to lie on a padded platform. A suspended mechanical arm then passes over parts of your body, taking images of your skeleton.

    The test generally takes between 10 and 30 minutes and exposes you to less radiation than a chest X-ray. A radiologist then reads the images and provides results, which include two components: T-score and Z-score.

    More articles

    Popular Articles