Does Medicare Cover Bone Density Tests?
Understand Medicare's coverage for bone density tests, including specific conditions, frequency, costs, and how Medicare Advantage plans apply.
Bone density tests, often referred to as bone mineral density (BMD) tests or DEXA scans, are a medical imaging technique used to measure bone strength. These tests help identify bone loss and diagnose conditions like osteoporosis, which can lead to increased fracture risk. Understanding how Medicare covers these screenings can help individuals manage their bone health.
Conditions for Coverage
Original Medicare, Part B, covers bone density tests when certain medical conditions or risk factors are present. A doctor’s order is required for Medicare to cover these tests. A woman whose doctor determines she is estrogen deficient and at clinical risk for osteoporosis qualifies.
Medicare also covers bone density tests if X-rays show signs of osteoporosis, osteopenia, or vertebral fractures. Individuals receiving or planning to receive glucocorticoid (steroid) therapy for extended periods are eligible for coverage. Those diagnosed with primary hyperparathyroidism, a condition affecting calcium levels and bone density, qualify for coverage. Coverage is also provided for monitoring to assess the response to an approved osteoporosis drug therapy.
Frequency and Patient Costs
Medicare Part B covers a bone density test once every 24 months. However, if a healthcare professional deems it medically necessary, more frequent testing may be covered. This allows for closer monitoring in situations where bone health changes rapidly or treatment efficacy needs regular assessment.
When the conditions for coverage are met and the test is performed by a Medicare-approved provider who accepts assignment, Medicare Part B covers 100% of the Medicare-approved amount for the test. Beneficiaries pay nothing for these preventive services. The Part B deductible and coinsurance do not apply to these covered bone density tests.
Understanding Medicare Advantage Plans
Medicare Advantage Plans, also known as Part C, are required to cover everything that Original Medicare covers. This includes bone density tests. If a test would be covered under Original Medicare, it will also be covered by a Medicare Advantage plan.
Medicare Advantage plans may have different rules regarding patient costs, network requirements, and prior authorization processes. For example, a plan might require beneficiaries to use providers within its specific network to receive full coverage. Individuals enrolled in a Medicare Advantage plan should review their specific plan’s benefits and network guidelines before scheduling a bone density test.