How Often Does Medicare Pay for a Bone Density Test?

A bone density test, also known as a DEXA scan, uses a specialized X-ray to measure the mineral content within bones. Its primary purpose is to assess bone strength, detect osteoporosis, and evaluate an individual’s risk of bone fractures. These tests aid in early diagnosis and management of conditions affecting bone integrity, helping prevent severe complications.

Medicare Part B Coverage for Bone Density Tests

Medicare Part B covers bone density tests. These tests are categorized as preventive services, aimed at identifying potential health issues early. The specific type of test typically covered is a central dual-energy X-ray absorptiometry (DEXA or DXA) scan. For Medicare to cover a bone density test, it must be ordered by a qualified physician or other healthcare provider. While Part B primarily covers outpatient tests, Medicare Part A may cover a bone density scan if performed during an inpatient hospital stay or within a skilled nursing facility.

Eligibility Criteria for Coverage

Specific medical conditions and risk factors determine a Medicare beneficiary’s eligibility for a covered bone density test. A doctor must certify the medical necessity of the test based on these criteria.

Individuals diagnosed with osteoporosis or those whose X-rays show signs of osteopenia or vertebral fractures typically qualify. Eligibility also extends to individuals with primary hyperparathyroidism, a condition affecting calcium levels and bone density. Those taking or planning to take steroid-type medications, such as prednisone, for an extended period are often eligible due to the medication’s known effect on bone health. Coverage is also provided for individuals being monitored to assess the effectiveness of their osteoporosis drug therapy.

Frequency of Covered Tests

Medicare generally covers a bone density test once every 24 months for eligible beneficiaries. This standard frequency applies when the test is performed as a preventive screening. The interval ensures regular monitoring of bone health for individuals at risk.

However, Medicare may cover bone density tests more frequently than the standard 24-month period if a doctor determines it is medically necessary. This includes monitoring treatment effectiveness or due to specific conditions like rheumatoid arthritis, chronic kidney disease, or certain hormonal imbalances.

Costs Associated with Bone Density Tests

For covered bone density tests that are medically necessary and performed by a Medicare-approved provider, Medicare Part B typically covers 100% of the cost. This means beneficiaries generally pay nothing for the test, with no deductible or coinsurance applied. The absence of out-of-pocket costs applies when the healthcare provider accepts Medicare assignment.

Ensuring the provider accepts Medicare assignment is important to avoid unexpected expenses. While Original Medicare Part B usually covers the full cost, Medicare Advantage Plans (Part C) must offer at least the same benefits but may have different rules regarding network providers, potentially impacting where a beneficiary can receive the test without incurring additional costs.