Does Medicare cover bone mass measurements?

May 31, 2011
[Your Name Here] in Wellness

Bone mass measurements (sometimes called "bone density tests") are given to evaluate your bone’s health by assessing your bone quality, calculating your bone mass and detecting any bone loss. Bone mass measurements can help determine if you need medical treatment for osteoporosis, a condition that causes "brittle bones" in many older adults. Starting January 1, 2011, if you are in Original Medicare and meet certain criteria that put you at risk for osteoporosis, a bone mass measurement is covered as a preventive service. This means you will have no coinsurance or deductible if you see a doctor who takes assignment. Doctors who take assignment are doctors who cannot charge you more than the Medicare approved amount.

According to Medicare.gov, you have to meet one of the following criterions that put you at risk for osteoporosis for Medicare to cover the bone mass measurement test:

 

1. A woman whose doctor (or other health care professional) is treating her for estrogen-deficiency and is at risk for osteoporosis based on her medical history or other findings 
2. A person with vertebral (spinal) abnormalities as demonstrated by an x-ray 
3. A person getting (or expected to receive) steroid treatments for more than three months 
4. A person with hyperparathyroidism 
5. A person taking an osteoporosis drug  

This test is covered as a preventive service once every 24 months if you are at risk. Medicare will also cover follow-up measurements or more frequent screening if your doctor prescribes them and says that they are medically necessary. In this case, Medicare will cover the screenings but you will have to pay a 20 percent coinsurance.

 

*source: adapted from "Dear Marci." Medicare Rights Center Volume 10, Issue 11.  Online.  http://www.medicarerights.org/medicare-answers/dear-marci.php viewed on 5/31/2011.

Article originally appeared on Tweedy Insurance Group (http://tweedyinsurancegroup.squarespace.com/).