Maintaining good bone health is crucial as we age, and bone density testing plays a role in assessing our bone strength and integrity. Knowing if Medicare covers bone density screening and how often it is recommended can be essential to hands-on healthcare management. This guide examines Medicare coverage for bone density scans, how often you should get tested, and the costs.
Bone scans measure the mass or density of minerals in your bone and are a key indicator of bone health.
Original Medicare and Medicare supplement plans cover bone density scans in various situations.
Doctors recommend bone scans for individuals with higher risk factors or who have been diagnosed with bone disease.
What is bone density testing?
A bone density test measures your bones' mineral content, such as calcium. It’s non-invasive, works like an x-ray, and is often called a DEXA or DXA scan (dual-energy x-ray absorptiometry). Bone scans show the strength and density of your bones and help doctors identify fractures and diagnose conditions such as osteoporosis, a disease that weakens bones and increases the risk of fractures.
Does Medicare cover bone density tests?
Medicare pays for the cost of bone density testing in several ways. Here’s how it may apply to you.
Medicare Part A
Medicare Part A pays for a bone density scan if it’s part of your inpatient care in a hospital or skilled nursing facility.
Medicare Part B
Medicare Part B covers your routine, outpatient bone density testing with a few basic conditions:
- Medical need. When your doctor determines it as medically necessary based on your medical history, risk factors, or specific symptoms related to bone health.
- Frequency. Once every 24 months unless you have a medical condition that requires more frequent scans.
- Eligibility. You’re enrolled as a beneficiary.
Medicare Advantage may cover bone density testing as a preventative or diagnostic service in addition to what Original Medicare (Parts A and B) covers. Your benefits for copayments, deductibles, and testing frequency will vary depending on your chosen plan.
How much does bone density testing cost?
If you’re covered by Medicare, understanding the cost of a bone density test is an important way to manage your healthcare expenses. While Medicare does cover bone density testing, there may still be some out-of-pocket expenses to consider.
- Medicare Part A. The Part A (hospitalization) deductible for 2023 is $1,600. You may have some coinsurance expenses after your first 60 days in the hospital.
- Medicare Part B. The Part B deductible for 2023 before Original Medicare starts to pay is $226, and you may need to pay a 20% coinsurance for bone density testing.
- Medicare Advantage. If you have a Medicare Advantage plan, your bone density test price will vary depending on the plan you select. Some plans may have lower or no out-of-pocket costs for bone density testing.
- Diagnostic vs. screening tests. Doctors order diagnostic tests when symptoms are present to determine why they occur. Diagnostic tests are typically covered with no added coinsurance costs. Screening tests are used to discover disease when it is still curable. Screening tests may involve some cost-sharing on your part.
- Frequency. Your doctor may recommend you have a bone density scan more often than Medicare covers or may recommend additional services not covered by Medicare. You may need to pay such expenses wholly or partially.
It's essential to review the details of your coverage and check with your healthcare provider to understand the extent of your coverage for bone density scans and any associated costs.
Should I have a bone density test?
Your doctor may recommend a bone scan for you if:
- You are a woman aged 65 years and older, a man aged 70 years and older, or you’ve had a broken bone at age 50 or older.
- You are a woman with estrogen deficiency and are at risk for osteoporosis.
- You’ve been diagnosed with osteoporosis, osteopenia, hyperparathyroidism, or vertebral fractures.
- You take prednisone or other steroids.
How often should I get a bone density test?
As with any medical test, your doctor may recommend repeating a bone density scan when the results influence your treatment plan. Your testing frequency also depends on your risk factors and medical history.
Medicare offers the following guidelines:
- If you have a high risk for bone disease or have been diagnosed with osteoporosis, you should have bone density testing every 24 months.
- If you are at lower risk, your healthcare provider may recommend less frequent testing based on age, gender, family history, and medication use.
Ultimately, your doctor will evaluate your unique circumstances in recommending how often you have a bone scan.
Where can I get a bone density scan?
Bone scans are available at outpatient facilities, imaging centers, hospitals, and some medical offices. The more qualified testing facilities have staff trained and certified by organizations such as the International Society for Clinical Densitometry (ISCD).
When scheduling, ensure the facility you select accepts direct payment from Medicare, that Medicare has approved the testing, and that you have a written prescription or referral.
What is ICD 10 for bone density screening?
When healthcare providers order bone density screenings, they use diagnosis codes from the International Classification of Diseases, 10th Edition (ICD-10) to indicate the medical necessity of the test.
The codes submitted to Medicare must be medically appropriate for a patient’s condition and consistent with their medical records on the service date. Using the appropriate ICD-10 code is crucial for ensuring that Medicare or your insurance provider understands the purpose of the bone density screening and approves coverage accordingly.
Bone density testing is critical to proactive bone health management, especially for seniors. Medicare generally covers bone density testing when medically necessary, and the testing frequency depends on individual risk factors. Coverage may vary if you have a Medicare Advantage plan, so it's essential to review your plan's specifics.
As you consider your bone health and Medicare coverage, consult your healthcare provider to ensure you receive the appropriate screenings at the recommended intervals. This will help maintain strong and healthy bones, reducing the risk of fractures and improving your overall quality of life as you age.
Will Medicare pay for bone density testing?
Medicare coverage pays for bone density testing depending on certain factors, such as your health circumstances and type of Medicare coverage.
What is the cost of bone density testing?
The cost of bone density testing will vary by the type of exam, the quality and location of the testing facility, and your insurance coverage. Your out-of-pocket expenses also will be determined by your Medicare coverage.
What diagnosis does Medicare cover for DEXA scan?
The diseases covered by Medicare for DEXA (Dual-Energy X-ray Absorptiometry) scans include osteoporosis, osteopenia (low bone density), and hyperparathyroidism.
Can anyone get a bone density test?
If you are concerned about your bone health and have a medical referral, you may get a bone density test. To receive payment from Medicare for a bone scan, you must be an enrolled Medicare beneficiary.