Did you have a DEXA scan before the 2 year mark covered by Medicare?
I am nearing the end of my Evenity regimen - my last shots will be in November. I would like to have a DEXA scan to see my bone density results but my next 2-year DEXA is not due until 6/17/2027. Research on the Medicare site indicates a DEXA before 2 years would be covered if considered medically necessary. I am hoping my Rheumatologist will code it so it is considered necessary due to osteroporosis and my scoliosis which she consideres is advanced due to the degree of my S curve. Has anyone had a DEXA covered before 2 years or did you have to pay for it out of pocket. I live in Pennsylvania.
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Yes. My Dr requested yearly due to osteoporosis. I get one yearly.
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2 Reactions@clandis3352 Thanks for you reply. Are they covered totally by medicare with no copay?
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1 ReactionNot only before the two-year mark: if you are on osteoporosis medication, Medicare will pay for more than one DEXA in a single year. I've done it.
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3 Reactions@njx58 Thanks for responding!
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1 ReactionLike chiefsmom, I have dexas yearly. Medicare pays. I also have bone markers every three months on Medicare. Medicare pays 80%
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3 ReactionsI asked at the center where I had my Dexa. They said usually Medicare pays for a Dexa every 25 months ( I as surprised by that....it sounded like a trick since most people would think 24 months/2 years). However, if on a bone med, the doctor could request one at 1 year...or probably 1 year and 3 days like the sheet said for my mammogram. I have mixed feelings about the 1 year mark on Forteo. I might shoot for an 18 month mark for a test.
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1 Reaction@njx58 My DEXA scans are covered by Traditional Medicare, Part B and my Supplemental Plan G. I do not have a Medicare Advantage plan that is sold and managed by a private insurance company.
I was diagnosed with osteoporosis many years ago. When I had a sacral fracture, the DEXA scan at that time showed significant bone loss. Based on that DEXA scan and my fracture, my endocrinologist prescribed 12 months of Evenity. Evenity was covered by Medicine Part B and my Supplemental Part G after I met my deductible of about $280 (this was a few years ago so I don’t remember that exact amount). After the 12 months ended, I had another DEXA scan which showed significant gains. I then had a Reclast infusion to lock in those gains. Reclast was also covered by my Traditional Medicare plans again.
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1 Reaction@naturegirl5 Thanks for your reply. How long ago was your Reclast infusion and how have your DEXA scans been since?
I do a Dexa with TBS every 6 months to watch my progress and stay motivated. My insurance (not Medicare) covers one test a year, so I self-pay. My Dr gives me a script.
Here's the breakdown of what it costs: At the hospital, $960 self-pay, at the local imaging center owned by the same hospital, if they bill my insurance first (and they deny it), and I pay the remainder-- $160, and if I state clearly that I am self pay, do not bill my insurance- $68 (make sure you sign a form for self pay and keep a copy- they are not used to it). It took a couple of phone calls to find out the rate I would pay, but it's worked ever since (except for the time they billed my insurance by mistake and I found out the remainder was $160- thank God I had a copy of the signed form). I'm in Florida, near Orlando. I hope yours is even cheaper!
Good luck!
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1 Reaction@luckypup You should get it at 12 months. Often, the bulk of the gains with Tymlos and Forteo come in the first year. Why wait 18 months?
Again, if you are taking meds, you can get a DEXA at 12 months and even sooner under Medicare.
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