Medicare and Bone Density Tests; What to Know

An unfortunate part of growing older is that your bones may weaken. And weakened bones can lead to broken bones. No one wants that—including Medicare. That’s why Medicare covers bone density testing. But there are conditions on how much and how often it will pay, so it’s a good idea to understand the rules.

What is bone density testing?
Bone density testing, also called bone mass measurements, uses x-rays to measure the density—or the amount—of bone in specific areas of your body, usually the hip or spine. These tests help determine if you have normal bone density, low bone density (called osteopenia), or osteoporosis, a condition that causes bones to weaken.

Who should get bone density testing?
Although it is typically more common in non-Hispanic white women and Asian women, osteoporosis can affect anyone. Risk factors can include:

• Age
• A family history of osteoporosis 
• Low levels of estrogen in women and low levels of testosterone in men 
• A diet that’s low in calcium and vitamin D 
• Low levels of physical activity 
• Smoking 
• Long-term heavy consumption of alcohol 
• Certain medical conditions such as diabetes, lactose intolerance, inflammatory bowel disease, liver or kidney disease, asthma, cancer, rheumatoid arthritis, HIV/AIDS, Cushing’s disease, multiple sclerosis, lupus, hyperparathyroidism or hyperthyroidism, and anorexia nervosa 
• Use of certain medications, such as proton pump inhibitors that lower levels of stomach acid and selective serotonin reuptake inhibitors (SSRIs) used to treat anxiety and depression

Since weakening bones are fairly common, even if your overall risk is low, your doctor may suggest regular testing. That can help your healthcare providers keep track of any changes in the density of your bones and stay ahead of potential risks for bone fracture or the development of osteoporosis. 

Are bone density tests covered by Medicare?
Under Original Medicare Part B, you can get bone density testing once every 24 months (or more frequently if medically necessary) if you meet one or more of the following conditions.

• You’re a woman and your doctor has diagnosed you with estrogen deficiency and has deemed you at risk for osteoporosis.
• Your x-rays show possible osteoporosis, low bone density, or spine fractures.
• You’re taking prednisone or other steroid-type drugs or will be starting such drugs.
• You have a primary hyperparathyroidism diagnosis.
• Your doctor is tracking how well your osteoporosis medication is working.

Medicare will cover the bone density testing in full if the testing is ordered by your doctor or another qualified health care provider. The caveat is that your test provider must have agreed to accept direct payment from Medicare at the price that Medicare has approved for the testing.

What bone testing costs might Medicare not cover?
Your doctor may advise that you get bone density testing more often than Medicare allows or may recommend other services in connection with the bone density testing that Medicare doesn’t cover. In such cases, you, or your supplemental insurance, if you have any, may have to pay some or all of those costs.

If you have a Medicare Advantage plan, it will cover anything Original Medicare does, including bone density testing. But it may offer additional benefits that aren’t covered by Original Medicare. Check with your plan for coverage specifics.

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