Bone density tests are used to measure the amount of calcium and other trace minerals in your bones with X-rays. These results will help your doctor determine if you are at risk of a bone fracture due to an underlying condition. Read on to learn more about how Medicare covers this important test.
- Bone density tests are usually conducted with X-rays diagnosed at an outpatient facility.
- Bone density tests are usually done every 24 months for qualifying patients.
- Bone density tests may be done more frequently if the patient suffers from certain conditions.
- People on Medicare pay no costs for bone density tests as long as their doctor accepts Medicare assignment.
- Medicare Advantage plans will cover bone density tests, but the beneficiary must use providers within the plan.
Medicare Part B covers the full cost of bone density testing every 24 months, but only if you meet the prerequisite conditions. That means you pay nothing out-of-pocket if you meet the three criteria.
What Are Bone Density Tests?
Bone density tests help your doctor diagnose any fractures and problems with bone density, such as osteoporosis or compression fractures. Bone density is usually measured with an imaging test like an X-ray, which will reveal the calcium density in your bones. If your bones are fragile, you will see large honeycomb-like structures when the doctor looks at your bones on a microscopic level.1mayoclinic.org, “Bone density test“, Accessed November 11, 2021
How Does Medicare Cover Bone Density Tests?
As we age our bones become more porous and fragile. Bone scans help your physician diagnose fractures and problems with bone density, such as osteoporosis. For this reason, Medicare covers bone scans every other year for the following conditions:2Medicare.gov, “Bone mass measurements“, Accessed November 11, 2021
- Estrogen deficient women at risk for osteoporosis
- Symptoms of osteoporosis, osteopenia, or vertebral fractures on an x-ray
- Prednisone or steroid-type drug use as part of a treatment plan
- Primary hyperparathyroidism
- Osteoporosis drug therapy monitoring
The 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 test, or you have a condition that requires more frequent testing.
- The facility where the scan is done accepts Medicare.
Frequent Bone Density Tests
You may qualify for more frequent testing if you have any of the following conditions:
- Rheumatoid arthritis
- Chronic kidney disease
- Overactive parathyroid gland and other hormonal imbalances
- Organ transplant
How Much Do Bone Density Tests Cost?
The cost for bone density tests can vary from area to area, ranging from $150 to $325 without coverage3Howmuchisit.org, “How Much Does a Bone Density Scan Cost?“, Accessed November 11, 2021. Medicare beneficiaries who meet the requirements pay no deductibles, coinsurance, or copayments for a bone density test if their health care provider accepts Medicare assignment.2Medicare.gov, “Bone mass measurements“, Accessed November 11, 20214KFF.org, “Your Guide to Medicare’s Preventive Services“, Accessed November 11, 2021
Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, in addition to any expanded services offered. That includes bone density tests. However, a beneficiary’s out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipment.5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 11, 2021
Like most diagnostic and preventative care services, Medicare will completely cover the costs of your bone density tests. If you have a family history of osteoporosis, you broke a bone with unusual ease, or you have been losing height, you should consult with your doctor for this test. Once your doctor has determined that you have a qualifying condition and gives the order for the test, Medicare will have you fully covered for it.
- 1mayoclinic.org, “Bone density test“, Accessed November 11, 2021
- 2Medicare.gov, “Bone mass measurements“, Accessed November 11, 2021
- 3Howmuchisit.org, “How Much Does a Bone Density Scan Cost?“, Accessed November 11, 2021
- 4KFF.org, “Your Guide to Medicare’s Preventive Services“, Accessed November 11, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 11, 2021