Is a DEXA scan covered by Medicare?

As a healthcare professional with expertise in medical imaging and insurance coverage, I'm often asked about the coverage of various diagnostic tests, including the Dual-energy X-ray Absorptiometry (DEXA) scan, which is a specific type of bone density test used to diagnose osteoporosis and assess the risk of fractures. Medicare, the federal health insurance program in the United States, has specific guidelines regarding the coverage of such tests. Is a DEXA scan covered by Medicare? Medicare does cover DEXA scans under certain conditions. Here's a detailed breakdown: 1. Medical Necessity: Medicare will cover a DEXA scan if it is deemed medically necessary by a physician. This typically means that the test is required to diagnose or monitor a specific medical condition, such as osteoporosis. 2. Frequency of Coverage: According to the information provided, Medicare may cover a bone density test, like a DEXA scan, more often than once every two years if your doctor believes it is medically necessary. This suggests that while there may be a standard interval between tests, exceptions can be made based on the clinical judgment of the treating physician. 3. Eligibility Criteria: There are specific eligibility criteria that must be met for Medicare to cover the test. These criteria are designed to ensure that the test is appropriate for the patient's condition and is not performed more frequently than is medically indicated. 4. Part B Coverage: If a healthcare provider accepts Medicare assignment, which means they agree to accept the Medicare-approved amount as full payment for their services, you may be eligible to receive the bone density test at no cost to you under Medicare Part B. This is an important consideration as it can significantly reduce out-of-pocket expenses for beneficiaries. 5. Out-of-Pocket Costs: Even when a test is covered by Medicare, there may still be some costs for the patient. These can include deductibles, copayments, or coinsurance, depending on the specific plan and the circumstances of the test. 6. Documentation and Pre-Approval: In some cases, Medicare may require pre-approval for a DEXA scan. This involves the physician providing documentation that supports the medical necessity of the test. Failure to obtain pre-approval when required can result in the test not being covered. 7. Changes in Coverage: It's important to note that Medicare's coverage policies can change, and it's always a good idea to check the most current information with Medicare or a qualified healthcare professional. 8. Supplemental Insurance: Many Medicare beneficiaries have supplemental insurance, such as Medigap or a Medicare Advantage plan, which may provide additional coverage for services like a DEXA scan. It's worth reviewing the specific benefits of any supplemental insurance to understand potential cost-sharing. 9. Communication with Providers: It's crucial to communicate with your healthcare provider about any concerns regarding insurance coverage. They can help navigate the process and ensure that all necessary steps are taken to maximize coverage. 10. Advocacy and Education: As a patient, it's important to be informed and advocate for the services you need. Understanding your rights and the coverage available to you through Medicare can help you make the best decisions for your health. In conclusion, while Medicare does cover DEXA scans, the coverage is subject to specific conditions and requirements. It's essential to work closely with your healthcare provider to ensure that the test is medically necessary and that all documentation and pre-approval processes are followed to maximize your coverage.

Medicare may cover a bone density test more often than once every two years if your doctor believes it is medically necessary and you meet the above eligibility criteria. You may be eligible to receive the bone density test at no cost to you under Part B if your health-care provider accepts Medicare assignment.Oct 3, 2017