A Bone Mass Measurement (BMM), typically performed using a Dual-Energy X-ray Absorptiometry (DEXA) scan, is a non-invasive procedure that assesses bone health. This test measures the density of minerals like calcium, providing the Bone Mineral Density (BMD) metric. Medicare Part B covers this procedure for qualified male beneficiaries who meet specific medical criteria. The purpose of the test is to identify bone weakness, diagnose conditions such as osteoporosis or osteopenia, and determine a patient’s risk of future fractures.
Understanding the Bone Density Test
The DEXA scan uses a small amount of X-ray radiation to produce images of the spine, hip, and sometimes the forearm, which are areas prone to fracture. The results are used to calculate a T-score, which compares the patient’s BMD to that of a healthy young adult reference population. This score helps determine whether bone density is normal, low (osteopenia), or significantly low (osteoporosis). While osteoporosis is often associated with women, men also face substantial risks, accounting for nearly one-third of all hip fractures annually. Early detection through BMM allows for timely intervention to slow bone loss and prevent debilitating injuries.
Specific Medicare Eligibility Requirements for Males
Medicare Part B coverage for a BMM is not based on age alone for men, but rather on the presence of specific medical conditions that increase the risk of bone loss. A physician must order the test and document the medical necessity using specific diagnostic codes (ICD-10) to secure coverage.
Qualifying conditions include:
- The presence of vertebral abnormalities, such as a spinal fracture or other fragility fracture identified through a standard X-ray. This finding indicates existing bone compromise.
- Receiving, or expected to receive, prolonged high-dose glucocorticoid (steroid) therapy for three months or longer. Glucocorticoids interfere with bone formation and accelerate bone breakdown, requiring close monitoring.
- A diagnosis of primary hyperparathyroidism, a condition where an overactive parathyroid gland causes excessive calcium to be pulled from the bones.
- Patients already undergoing FDA-approved drug therapy for osteoporosis, as the test monitors the treatment’s effectiveness in maintaining bone density.
- When the physician determines it is medically necessary to monitor a patient with other specific conditions known to lead to bone loss. These include chronic kidney disease, hormonal imbalances, or conditions related to organ transplants.
Frequency and Covered Test Types
Medicare defines the covered procedure as a Bone Mass Measurement (BMM), which typically refers to the axial DEXA scan that measures the hip and spine. This central scan is considered the gold standard for diagnosing and monitoring osteoporosis. Other, less common screening methods, such as peripheral scans of the heel or wrist, may not be covered under the same BMM rules.
Medicare generally limits the frequency of the BMM to once every 24 months, meaning at least 23 months must have passed since the previous covered test. However, this two-year rule can be bypassed if a physician deems more frequent testing to be medically necessary. For instance, a patient starting a new osteoporosis medication might require a follow-up scan sooner to assess the immediate impact of the treatment.
Patient Costs Under Medicare Part B
The BMM is covered under Medicare Part B, which handles outpatient medical services and preventative care. For beneficiaries who meet one of the qualifying medical conditions, the BMM is categorized as a preventive service. When a preventive service is covered and the testing facility accepts Medicare assignment, the beneficiary typically pays nothing.
This means that the Part B deductible and the standard 20% coinsurance are waived for the BMM. Patients with Original Medicare should verify that the provider accepts assignment to ensure the $0 cost. For beneficiaries enrolled in a Medicare Advantage Plan (Part C), the plan must cover the BMM at least as comprehensively as Original Medicare. However, the specific out-of-pocket costs, such as copayments or coinsurance, may vary depending on the plan’s structure and network requirements.