- As we age, our bones can lose density and weaken.
- People who take certain medications and who are female are especially at risk.
- To help manage bone density loss, Medicare will cover bone scans.
- Medicare coverage will reduce your share of the cost for bone scans.
As people age, bones become more porous and the risk of bone problems increases. Bone scans can help your doctor diagnose broken bones, fractures, or problems with bone density, such as osteoporosis.
Medicare recognizes this risk and offers coverage for bone scans every other year. Find out how much you might have to pay and what other criteria you have to meet before you get a bone scan.
Bone density is usually measured with an imaging test similar to an X-ray. This scan will give your doctor information about the health and strength of your bones.
Several types of bone density tests exist. The preferred test is now the bone density mineral test. Medicare removed other similar tests when it updated the current benefit guidelines in 2007.
Because certain conditions put you at a higher risk for bone problems and related injuries, Medicare covers bone density testing once every 24 months.
You may qualify for more frequent testing if you have any of the following conditions, which could lead to decreased bone density:
- rheumatoid arthritis
- chronic kidney disease
- overactive parathyroid gland and other hormonal imbalances
- organ transplant
Most outpatient facilities with radiology services can perform a bone density scan. This may be:
- an outpatient facility
- a medical office building
- a hospital
- another imaging center
The basic conditions for coverage are:
- Your doctor has ordered the scan as a medically necessary test.
- It’s been 23 months since your last bone density scan or you have a condition that needs more frequent testing.
- The facility where the scan is done accepts Medicare.
To check whether a medical facility participates in Medicare, click here.
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.
- You’re 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 Medicare’s covered services list.
Medicare Part A may cover a bone scan if it’s part of an inpatient stay in a hospital or skilled nursing facility.
If you need a bone density scan and your doctor agrees that you’re eligible for the test, Medicare will cover one test every 2 years — or more often if your specific condition requires it.
If you meet these conditions and the facility that performs your scan participates in Medicare, you bone scan test will be completely covered under Medicare Part B at no cost to you.
Medicare Advantage (Part C) must match the coverage of original Medicare (Part A and Part B). However, each plan may have its own requirements on where you can be tested and how much your share of the cost will be.
Medicare Advantage plans may help you save on costs, depending on what kind of healthcare services you need and your monthly budget.
In other words, if you meet the requirements for the test, you should have no out-of-pocket costs for your bone scan using original Medicare.
Medicare Advantage plans may have different requirements for locations, such as remaining within a certain network, in order to get full coverage.
A bone density test is an imaging study that uses a small amount of ionized radiation and an X-ray machine to measure the strength of your bones.
Also called dual energy X-ray absorptiometry (DEXA), this test allows your doctor to measure the amount of minerals — like calcium — in your bones.
This test can be used to find mineral deficiencies that may be caused by:
- age or certain diseases
- increased air space (pores)
- other problems in your bones
A number of hereditary and lifestyle traits can contribute to bone loss and weakness. Your doctor will assess your risk based on several factors, including:
- tobacco use
- excessive alcohol consumption
- long-term steroid use
- low body weight or chronic malnutrition
- rheumatoid arthritis
- previous bone trauma
- chronic kidney disease
What can I expect with a bone density test?
You don’t 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.
- The full cost of a bone density scan is covered under original Medicare every 24 months.
- If you need to have a bone density test more often, your doctor will have to provide proof of a reason for more frequent testing.
- You may be asked to have your test done within a certain network if you have a Medicare Advantage plan. If you go outside your network, you may have to pay a share of the testing cost.
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