Does Medicare Cover Bone Density Testing?

Through bone density testing, seniors may learn whether they’re at risk for broken bones. This Medicare-covered procedure may be deemed medically necessary for beneficiaries in certain risk categories or those who exhibit symptoms of bone loss such as fragility fractures or loss of height. Learn how often Medicare covers bone density testing and why your plan may let you get tested more frequently.

Does Medicare Cover Bone Density Testing?

Yes, Original Medicare and Medicare Advantage generally cover bone density testing and other bone mass measurements once every 24 months. However, Medicare may approve coverage for more frequent testing in the following situations:

• You’re undergoing osteoporosis drug therapy.
• You’re taking (or will be taking) prednisone or other steroidal drugs.
• You have a diagnosis of primary hyperparathyroidism.
• You’re an estrogen-deficient woman who may be at risk for osteoporosis based on your medical history.
• You may have osteopenia, osteoporosis or vertebral fractures based on X-rays or other diagnostic imaging.
• You have a medical condition, such as chronic kidney disease, that increases your risk of a bone-related injury.

How Much Does Medicare Cover for Bone Density Testing?

If bone density testing is done on an outpatient basis, it may be fully covered under Medicare Part B. To ensure that you’ll incur no out-of-pocket costs, the test must be deemed medically necessary by the prescribing physician and performed at a Medicare-approved facility. At least 23 months must have passed since your last bone density test, unless you’re approved for more frequent testing. If you qualify for more frequent testing, your physician must provide proof of medical necessity.

Bone density testing may also be done as part of an inpatient stay at a hospital or skilled nursing facility. In these cases, testing is reimbursable under Part A, Medicare’s hospitalization component. Once the Part A deductible has been met, the test is fully covered as long as it’s performed during your first 60 days at the facility. If it’s performed after 60 days, you may be responsible for paying a coinsurance.

Medicare Advantage (Part C) beneficiaries are guaranteed to receive, at minimum, the same coverage as that provided under Original Medicare. However, certain plans may provide additional coverage for bone density testing. For your plan’s specific coverage terms, contact your Medicare advisor or a plan administrator.

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What Is Bone Density Testing?

Bone density testing, which is sometimes referred to as bone densitometry or DEXA, is a type of imaging that measures how many bone minerals, including grams of calcium, are in a section of bone (typically the spine, hip or forearm). A higher concentration of mineral content means denser, stronger bones, which are generally less likely to break. 

Bone density testing is often used to confirm whether an individual has osteoporosis, which is indicated by fragile bones that may break easily. The test may also be helpful in determining an individual’s risk of fractures and is often used to monitor a person undergoing treatment for osteoporosis.

This test may be ordered as part of a routine screening for an aging individual, or it may be recommended if you’ve fractured a bone, had a drop in hormone levels or experienced a significant loss of height.

How Is Bone Density Testing Done?

Bone density testing is typically done in a clinical setting such as a hospital or an outpatient facility. After putting on a loose gown, you’ll be asked to lie on a padded platform. A suspended mechanical arm then passes over parts of your body, taking images of your skeleton.

The test generally takes between 10 and 30 minutes and exposes you to less radiation than a chest X-ray. A radiologist then reads the images and provides results, which include two components: T-score and Z-score.

T-Score

The T-score compares your bone density with one that would be expected of a healthy young adult of the same gender. It’s expressed as a number of units, or standard deviations, which represent how far above or below your bone density is from the comparable. T scores of -1 and above are considered normal while a T score of -2.5 and below may indicate osteoporosis. Scores that fall between those two numbers indicate a low bone density that may lead to osteoporosis.

Z-Score

The Z-score uses a measurement process similar to the T-score, but results are compared to a normal expectation for someone of the same age, gender, weight and racial origin as the person undergoing the test.

If your T-score or Z-score results are significantly higher or lower than the norm, your doctor may order additional tests.

How Accurate Are Bone Density Tests Done at Health Fairs?

Health care providers may offer free bone density testing at health fairs and other off-site events. These tests, which are done using small, portable imaging devices, measure the mineral composition of the bones in your extremities, which may include a finger, wrist or heel. But because bone density can vary considerably throughout the body, these measurements won’t predict your risk of fracture as accurately as a test done using your spine or hip.

If you receive a questionable result after a test done on a portable device, your physician may recommend additional imaging of the hip or spine for a more comprehensive picture.

Are Bone Density Testing and Bone Scans the Same?

No. Bone scans fall into the category of nuclear imaging. These diagnostic tools are typically used to detect cancer, infections, existing fractures and other bone abnormalities.

Individuals undergoing a bone scan receive an injection of a radioactive contrast material prior to imaging while no contrast materials are required for standard bone density testing. Imaging for bone scans may also be done in multiple phases, as opposed to the single imaging process required during a bone density test.

What Can Contribute to Bone Loss?

Bone loss often happens as a natural part of the aging process, but other factors may increase an individual’s risk of osteoporosis. These may include:

• Gender
• Low body weight
• Chronic kidney disease
• Drinking alcohol
• Smoking tobacco
• Diabetes
• Organ transplants
• Gastric bypass
• Hormone-blocking treatments
• Low calcium or vitamin D intake
• Long-term steroid use
• Rheumatoid arthritis
• Previous bone trauma
  
  

Unfortunately, bone loss may also occur when an individual has no known risk factors, which is why bone density testing can be an important tool in catching problems early and maintaining bone health.