Medicare Coverage of Bone Mass Screening
What It Is
Bone mass screening for osteoporosis; also called bone density screening
Medicare Part B can cover bone mass (density) measurement, prescribed by a doctor, for patients who meet any of the following conditions:
Women who are being treated for low estrogen levels and who are at clinical [risk of osteoporosis] (https://www.caring.com/articles/osteoporosis-risk-factors), based on condition and medical history
Men or women whose X-rays show possible osteoporosis, vertebrae fractures, or other bone disease
Men or women currently taking, or about to begin treatment including, prednisone or steroid-type medication
Men or women diagnosed with primary hyperparathyroidism
Men or women currently on osteoporosis drug therapy
Medicare Part B covers the test for bone mass measurement every two years for patients who meet one of these conditions, and more often if medically necessary as determined by a physician and approved by Medicare.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for bone mass screening, contact the plan directly.
What Medicare Pays
In 2010, if the screening is performed in a doctor's office, at an outpatient clinic, or at an independent laboratory, Medicare Part B pays 80 percent of the Medicare-approved amount. If the screening is provided at a hospital outpatient clinic, Medicare Part B pays the entire cost except for a co-payment, for which the patient is responsible.
Beginning January 1, 2011, Medicare Part B pays the full cost of a covered bone mass screening, regardless of where it's performed.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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