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Will Insurance Cover Testing for Osteoporosis?

  • The National Osteoporosis Foundation (NOF) states that Medicare reimburses DEXA scans if the referring physician orders it in advance as medically necessary because the patient is:

    • An estrogen-deficient woman (whether or not she is on hormone replacement therapy, the healthcare provider can decide if their patient is estrogen-deficient without clinical laboratory tests)
    • An individual with vertebral abnormalities
    • An individual receiving long-term glucocorticoid therapy
    • An individual with primary hyperparathyroidism
    • An individual being monitored to assess the response to or efficacy of a FDA-approved osteoporosis drug therapy

    Medicare reimburses for repeat DEXA scans every two years as long as the person is considered in one of the five qualified groups. This can be repeated sooner if the patient is expected to receive the equivalent of 7.5 mg/day of the drug Prednisone for more than three months.

     

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