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@prarysky Your hospital and other folks doctors who say you can only get DXAs every two years are doing everyone a great disservice. There is a general original Medicare guideline for screening for osteoporosis which says, DXAs is limited to every 23 months. But Medicare specifies a number of exceptions to this general screening guideline. One exception is for monitoring the effect of osteoporosis drugs. These exceptions are stated in the Medicare guidelines and there are appropriate codes to go along with those exceptions. The problem for many of us is not the Medicare rule but the doctors and staff not knowing the rules well or being willing to make the small extra effort.
I've had 6 or 7 DXAs over the past few years and most of those were done around a year apart. I've also paid for them when I wanted to know where I was at in less than a year's time.
BTW I checked this with the two AI programs I've been experimenting with, ChatGPT (my favorite) and Claude. Both gave excellent answers when asked about the supposed two year limit. They can list the general rule, the exceptions, the codes and how the reason for the DXA should be stated and so on. I prefer ChatGPT usually, but they are complementary so on important matters I sometimes use both. Remember they are not perfect and can make mistakes and give wrong answers, but that is more of a relief to me at this point than a problem. Oh yes, I'm using the free desktop windows versions of those at present.
Good luck on getting a DXA scan when you need it!
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@awfultruth. Thank you for adding your experience and knowledge! I'm going to take your advice and plug in my diagnostic and procedure codes to Claude AI which I've used the most. Will compare to ChatGPT which I've not used. These are the codes my doctor is using: CPT cod 770809 and diagnostic code M81.6.
I thought I knew what I would be paying out of pocket for my Dexa but realized that may not have included any additional fees from radiology. I think most of the interpretation is done by the software but could be wrong about that. In any case, I figured the hospital would be adding another charge to the Dexa. I was right about that and turns out the person who quoted me about $320 did not give me accurate information. The hospital only discounts the scan if you pay in advance. Including the "reading" fee it is about $1205 billed to insurance or you can pay $422 in advance.
I wish that Northwestern would apply the same discount if Medicare rejects the claim but the hospital says no. You must make a choice to pay the discounted price in advance or roll the dice with Medicare. If Medicare won't pay, you will owe the amount billed to Medicare (Medicare's coverage is close to the amount billed).
You can't get an answer from Medicare about coverage even providing the diagnostic and procedure codes. Nor can you get an answer from Northwestern despite the fact I know their billing department has billed Medicare many times using the same diagnostic and procedure codes and knows if they work.
Thank you again!
p.s. also good to know you are using the free versions of AI.