Medicare Coverage for Bone Density Scans: Requirements & Guidelines

Bone-density testing measures, by X-ray, the mass of certain bones in the body in order to assess overall bone quality and is most commonly performed to identify osteoporosis, or bone loss. One of the factors that puts individuals at risk for developing osteoporosis is age. People over the age of 50 have an increased risk and should be routinely tested. Most patients age 65 and older rely on Medicare for their health coverage. Medicare covers bone-density testing every 24 months for "qualified individuals." Once identified as "qualified," additional coverage criteria must be met.

Qualified Individuals

• In Medicare terms, a "qualified individual" is a beneficiary who meets at least one of the following criteria: a patient receiving steroid therapy for three or more months, an estrogen-deficient woman, an individual with known primary hyperparathyroidism, a patient taking FDA-approved osteoporosis medication or someone with vertebral abnormalities that are indicative of bone loss.

Additional Criteria

• All of the following additional criteria must also be met for coverage: the service must be provided by a qualified provider and be reasonable and necessary, and the test must be performed on the order of the patient's treating physician after determining appropriateness. In addition, the test must be performed with an FDA-approved device for the purpose of determining bone quality and include a physician's interpretation.

More Frequent Testing

• If medically necessary, Medicare may cover bone-density testing more frequently. Medical necessity usually is based on the monitoring of long-term steroid therapy or the determination of a baseline in order to monitor in the future.