Common Questions
What are Medicare bone density reimbursement guidelines?
In July of 1998, following passage of the Bone Mass Measurement Coverage Standardization Act, HCFA* published guidelines for coverage in the following patients:
- Estrogen-deficient women at clinical risk for osteoporosis
- Individuals with vertebral abnormalities as demonstrated by x-ray
- Individuals receiving, or planning to receive, long-term glucocorticoid (steroid) therapy
- Individuals being monitored to assess the response to or efficiency of an FDA-approved osteoporosis drug therapy
The policies of most private insurers seem to emulate these coverage rules.
Medicare might not pay for density testing for women under 65 who are on HRT and will not pay for testing in healthy premenopausal women. The rationale for these decisions is that HRT represents effective therapy and monitoring of treatment would not add information that would change practice. Links providing more information on payment issues are:
http://www.medicare.gov/Health/Osteoporosis.asp
* Health Care Financing Administration