Preventive screenings, such as bone density tests, can help identify potential medical problems. Medicare covers some costs.
Bone density tests may help prevent expensive reparative treatments. Medicare generally covers such tests, although there may be other out-of-pockets costs.
This article looks at bone density scans and osteoporosis, including risk factors. It also discusses Medicare coverage of the tests, along with costs.
If a doctor thinks a person may have osteoporosis, they may ask for a bone density scan, which uses an X-ray to measure bone mineral density.
The test may be done in a hospital setting or by using a mobile device. In general, a person will get the hospital test for a hip or spine X-ray, while the mobile test is done on a person’s finger, wrist, or heel. However, the type of test may depend on the community’s access to equipment.
According to the National Osteoporosis Foundation (NOF), if the test cannot be done on a person’s hip or spine, then it could be done on a person’s radius bone, which is in the forearm.
Osteoporosis is a medical condition that causes decreases in a person’s bone density, which can lead to fractures of the hip, spine, or wrist following a fall or other trauma.
After a doctor confirms a person has osteoporosis, recommended treatments may include medications and lifestyle changes such as getting more exercise and increasing intake of calcium and vitamin D.
Women are more likely than men to experience osteoporosis due to age-related hormonal changes. For example, after menopause, a woman’s estrogen levels drop. Estrogen is one of the hormones responsible for stimulating osteoblasts, which are cells that promote bone growth.
Other osteoporosis risk factors include:
- lack of bone-building vitamin D and calcium in the diet
- smoking cigarettes
- drinking alcohol excessively
- being sedentary
- having a too-low body weight
- having a medical history of a parent who broke their hip
If a person has several of these risk factors, a doctor may recommend a bone density scan.
A bone density test is also called a dual energy X-ray absorptiometry (DXA). The test is a non-invasive, painless X-ray scan of the hip and spine. A person does not need to do or wear anything special to get the test, and the entire scan typically takes 15 minutes or less.
Once a person has had a bone density test, a doctor trained in reading the scans will view the images and use calculations to assign a T-score, which compares a person’s current bone density to that of a healthy adult at age 30. Three T-score categories exist:
- normal bone density: -1 or higher (such as 0 or +0.5)
- low bone density: between -1 and -2.5
- osteoporosis: -2.5 and lower
In addition to receiving a T-score, a person may also receive a Z-score. This is a score that compares a person’s bone density to someone of the person’s similar age and size. These scores are usually more effective in identifying bone density levels in children, teenagers, and younger men and women, according to the National Osteoporosis Foundation.
Medicare covers bone density tests provided a person meets certain criteria for getting the scan. These criteria may include age and gender as well as personal medical history and risk factors that may put a person at greater risk for decreased bone density.
If a person meets Medicare’s requirements for a bone density scan, they may not have any costs associated with the scan. However, the doctor performing and interpreting the scan must accept Medicare assignment.
In that case, a person does not have to pay copays or the Part B deductible for a bone density scan. Medicare will pay the doctor and the center performing the scan an agreed-upon amount.
As a general rule, a person should check with Medicare before undergoing a bone density scan. Sometimes, a doctor’s office may help a person conduct this check, which is also called a pre-authorization. This process can ensure the doctor accepts assignment and ensures they will not provide services that Medicare does not cover and that a person is then responsible for paying.
What is Medicare?
Medicare has four parts, and each one has a different purpose and various costs related to paying for healthcare:
- Part A: Medicare Part A is the portion that pays for hospital-related costs and inpatient skilled nursing or rehabilitation treatments. Most Americans who worked and paid Medicare taxes for at least 10 years do not have to pay a premium for Part A.
- Part B: Medicare Part B helps pay for medical costs, including doctor’s visits and durable medical equipment. Unless a person is receiving financial assistance from Medicaid or other organizations, they will usually pay a Part B premium.
- Part C: Part C is Medicare Advantage, which is where a private insurance company covers a person’s Part A, Part B, and sometimes Part D benefits. Medicare requires these plans to cover all the benefits that Original Medicare offers, which would include bone scans. A person may pay a monthly premium for Medicare Part C. However, many plans are offered premium-free.
- Part D: Medicare Part D is the Medicare portion that pays for prescription drug coverage. Every person who qualifies for Medicare is required to have a Part D plan to help pay for the cost of their medications.
When a person qualifies for original Medicare (usually by turning age 65 or having a qualifying disability or medical condition), they will generally automatically get a Medicare card that allows them to get benefits. In some cases, a person may have to register to get the Medicare card.
Medicare Part B is the Medicare portion responsible for paying for a bone mass measurement test. Medicare will cover a test once every 24 months for a preventive screening if they meet the following requirements:
- a doctor certifies a woman is at risk for osteoporosis due to estrogen deficiency or medical history
- a person’s X-ray shows signs of osteoporosis, osteopenia, or fractured vertebrae
- a person has been taking medications known to affect bone health, including prednisone or other steroid-type medications
- a doctor has diagnosed a person with primary hyperparathyroidism, a condition that affects the body’s calcium stores and causes thinning bones
- a person is undergoing osteoporosis treatments, and a person requires a bone density test to track their treatment’s effectiveness
A person may also qualify for more frequent bone density scans if a doctor declares the tests medically necessary. Whether Medicare covers more frequent screenings depends upon a person’s health and medical reasons for the increased frequency.
Medicare will cover bone density scans for a person who meets certain medical requirements, such as osteoporosis risk factors.
Identifying thinning bone or osteoporosis at early stages before a person breaks a bone can allow them to receive treatments that may help reduce the risk of broken bones.