Medicare and Bone Density Tests

Bone density tests also referred to as bone mass measurements is a diagnostic test for osteoporosis. It is used to measure bone density and determine the risk of breaking a bone.

The test is usually performed using a dual x-ray absorptiometry (DXA) machine that measures the amount of bone in the spine, hip, and other bones.

The test results will help a healthcare provider make recommendations to protect and prevent further bone loss.

A bone density test is used to determine if a person has low bone density. People with low bone density have a higher risk of breaking a bone. Bone mass measurements can help a healthcare provider determine:

if a person is suffering from low bone density
the best treatment for improving bone density
if current therapies are effective in addressing bone loss
if the condition is getting worse
a person’s risk for breaking a bone in the future

Who should undergo a bone density test?

Postmenopausal women, men ages 70 and older, or those who recently suffered from a broken bone are advised to take a bone density test. Women are at high risk for osteoporosis. Bone loss is women is fastest during the first few years after menopause and continues into old age.

Men, on the other hand, start to lose bone mass at a faster rate at the age of 65.

Additional factors to consider for people who are at high risk for losing bone mass is a small body frame and long-term use of corticosteroids.

The National Osteoporosis Foundation recommends that people taking osteoporosis medications undergo a bone density test every one to two years. People who are starting a new osteoporosis medication are advised to repeat a bone density test after a year.

Medicare Part B (Medical Insurance) covers bone density tests every 24 months if a person is determined by a health provider to be at risk for osteoporosis. Medicare considers you to be at high risk if:

you are a woman found to be estrogen-deficient
x-ray shows that you are suffering from vertebral abnormalities
you are receiving daily steroid-type treatments, corticosteroids, or prednisone for more than three months
you have been diagnosed with hyperparathyroidism
you are receiving osteoporosis drug therapy

All these tests are covered if the doctor “accepts” the assignment. However, a doctor may recommend additional tests more than Medicare covers. In such cases, you may be asked to pay for some or all the costs.

How Much Will Medicare Pay?

People enrolled in Original Medicare and satisfy all the conditions set for coverage are entitled to 100% coverage of the Medicare-approve amount from a participating provider. Medicare pays for all the costs of the bone density test (no deductibles or coinsurance) if performed by a participating provider.

These providers will accept the assignment and only charges Medicare-approved amounts as full payment. Bone density tests conducted by a non-participating provider should be prepared to make payments. It is because bone density tests by non-participating providers may cost more than the maximum amount Medicare covers.