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66 and DXA shows Osteoporosis w/High Fracture Risk
Osteoporosis & Bone Health | Last Active: 5 days ago | Replies (39)Comment receiving replies
@frog100 How are some of us getting DEXA yearly? I am on original medicare with part G; my endocrinologist said no DEXA for 2 years; would love to private pay but am running into a brick wall there also (quote from $400 -$1200, depending on discounts, and I can't get it "in writing"). I have called a couple of places, and they won't do it without a doctor's referral (my referral is for the folks that quote me $400-$1200 and they never heard of TBS add on). Dexafit here doesn't do actual osteoporosis screening; more body composition. Is there a magic code number I can ask my doc to try? I just want to know if Reclast is working per DEXA, even just a little before I decide to do a second infusion, or possibly change meds if not?
Replies to "@frog100 How are some of us getting DEXA yearly? I am on original medicare with part..."
@jozer I am on traditional Medicare Plan F and spoke directly to Medicare. I was told DEXA scans can be ordered as often as your doc dtermines as medically necessary to monitor treatment. My provider orders yearly, as it takes time for bone growth (or loss) to show on the scans. Sad that growth is so slow. In order to use the same machine, when first established with my specialist and to habe the TBS included, they offerred a self-pay option that included a free TBS for only $110. Even though I had recently has a DEXA done locally 3 months earlier, I jumped at the opportunity, so I could use the same machine & tech moving forward with treatment. Again, my orovider thought I had to wait one year, plus a day, to repeat, but that is simply incorrect. Shame on Medicare for not better communicating that to our providers to help with treatment decisions for those of us barely hanging on with side effects.
@jozer
Since Medicare’s default coverage is every 24 months, getting an annual (12-month) scan requires your doctor to provide clinical justification for "medical necessity" using a reason like "monitoring osteoporosis treatment" rather than just "screening".
I'm not just idly wondering about my bones here. I'm taking injections every day (Tymlos) that produce a host of unpleasant side effects (nausea, dizziness, tiredness, muscle/joint pain, headache, and belly flab to varying degrees), and I need to know if it's working sooner than 2 years. "Monitoring osteoporosis treatment" is a valid medical necessity.
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@jozer
The Endo doctor I was seeing had me do one annually. Unfortunately she left and not as happy with those I have been to now. I need to find out too if our DEXA machine will do TBS. I am small boned and petite and it would benefit me. I also have Medicare G and it will cover annual DEXA’s for OP, if billed (coded) correctly. Yes you do need a doctor’s RX. Since you do have the type of Medicare that you can go anywhere, can you change doctors? After reading everyone’s posts I have learned and researched so much more to make the best decisions for me.