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Bone health becomes a cause of concern as individuals age, particularly for women post-menopause. The aging process leads to a gradual loss of bone mass, which makes bones more fragile and susceptible to fractures.
Resulting conditions like osteopenia and osteoporosis are widely prevalent among older adults. According to the CDC, osteoporosis affects nearly 20% of women aged 50 years and above, along with around 5% of men in the same age group.
Given these risks, bone density tests or bone mass measurements are key to assessing bone health. Healthcare providers use an imaging test similar to an X-ray to measure bone density and gain insights into bone health and strength. These tests are necessary to identify individuals who may require medical intervention to prevent or manage osteoporosis, which can result in brittle bones and increased vulnerability to fractures.
The question is, ‘How much does Medicare pay for bone density tests? In this article, we explore Medicare coverage of bone density tests and shed light on the eligibility criteria and coverage details.
Does Medicare Cover Bone Density Test?
Medicare Part B covers bone density or bone mass measurement tests once every two years for individuals at risk of osteoporosis and with a referral from their healthcare provider.
Medicare considers several factors to determine if you are at risk:
- Being an estrogen-deficient woman.
- Having vertebral abnormalities.
- Receiving daily steroid treatments for more than three months.
- Having hyperparathyroidism.
- Receiving osteoporosis drug therapy.
Medicare may cover follow-up measurements or more frequent screenings if prescribed by your doctor.
You may qualify for more frequent testing if you’ve had an organ transplant or if you have conditions such as rheumatoid arthritis, chronic kidney disease, overactive parathyroid gland, hormonal imbalances, or diabetes. Most outpatient facilities with radiology services can perform bone density scans.
To be eligible for coverage, your doctor must order the scan as a medically necessary test, and it must have been 23 months since your last scan, or you have a condition requiring more frequent testing. The facility doing the scam must accept Medicare.
Documentation from your doctor is necessary to ensure coverage. Medical necessity for bone density tests could involve monitoring progress while taking osteoporosis medication, having primary hyperthyroidism, or having an estrogen deficiency.
Medicare covers 100% of the approved cost of bone mass measurement tests when a participating provider conducts them. Medicare Advantage plans must also cover bone density test costs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare eligibility requirements.
If your provider discovers a new problem during the bone density test or needs to further investigate an existing problem, the additional care is classified as diagnostic. Medicare may bill you for any diagnostic care received during a preventive visit.
Make sure to check with Medicare before undergoing a bone density scan to ensure coverage. This is to prevent unexpected costs for services that Medicare does not cover.
If I don’t qualify, what other bone tests does Medicare help pay for?
If someone does not meet the qualifying criteria for bone density tests under Medicare, there are other options for bone-related treatment coverage. Medicare covers a range of services related to bone health and osteoporosis prevention, including:
- Medication: Medicare Part D (prescription drug) plans cover medications like bisphosphonates that are used to treat osteoporosis and reduce the risk of fractures.
- Home Health Services: If you qualify, Medicare covers parts of home health services like physical therapy and rehab services to help maintain bone health and mobility.
- Skilled Nursing Facility Care: Medicare covers skilled nursing facility care for eligible beneficiaries who need skilled nursing or rehabilitation services.
- Hospital Care: Medicare Part A covers hospital care, including inpatient hospital stays for bone fractures or other related conditions.
Please note that coverage and eligibility for these services may vary, so it’s advisable to check with Medicare or your healthcare provider for specific details based on your individual circumstances.
Navigating the world of healthy living with medical assistance can be challenging. Reach out to CoverRight for assistance in finding the best Medicare plan for your needs.
FAQs
Where can I get a bone density test taken?
You can get a bone density test at a hospital, medical clinic, imaging center, physician’s office, or outpatient center. Check with your healthcare provider or insurer for the most suitable location for your test, as coverage and availability may vary.
Are there any out-of-pocket expenses for a bone density test when I am on Medicare?
If you meet the qualifying criteria for a bone density test under Medicare, there are typically no out-of-pocket expenses. Medicare Part B covers bone density tests once every 24 months (or more frequently if medically necessary) for eligible beneficiaries. Coverage includes 100% of the Medicare-approved amount for the test, with no coinsurance or deductible required. It’s important, however, to verify coverage details with your healthcare provider and Medicare plan to ensure you meet the qualifying criteria and understand any potential costs.
