GoBucks10 months ago

Weird. First of all, a dexascan should cost 1/2 that much. Secondly I have now had 2 covered my Medicare. My dexascan was done at a hospital. Do you use Dr Vinnie Boombatz?

GMan-62 in reply to GoBucks10 months ago

Thanks for the Information. I live in Pensacola, Florida and had the scan done at a Baptist Hospital facility. Do you by chance know what ICD code was used? I'm probably going to have to call billing at the hospital and find out what happened and if they will resubmit. If I have the proper ICD code I can tell them what to use. I run into a lot of providers that submit the wrong codes and I have to find them. I'm seeing Dr. Timothy Brand Urology Oncology and Dr. James Adams Radiation Oncology. Both at Baptist Hospital. Baptist Hospital has a partnership with the Mayo Clinic.

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Gabby643 in reply to GoBucks9 months ago

Rodney's best!

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tango6510 months ago

Yes, for sure you can get one every 2 years and more frequently if medically justfied.

GMan-62 in reply to tango6510 months ago

Thanks for the response. That's what I thought from everything I've read, but for some reason it was denied. Do you by chance have the ICD code they billed with. Thanks.

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tango65 in reply to GMan-6210 months ago

cms.gov/medicare-coverage-d...

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tango6510 months ago

They are covered, I have had several along the years, every 2 years and they were always covered.

tango6510 months ago

It is confusing . The full version of the regulations says:

80.5.6 - Beneficiaries Who May be Covered

(Rev. 70, Issued: 05-11-07, Effective: 01-01-07, Implementation 07-02-07

"To be covered, a beneficiary must meet at least one of the five conditions listed below:

1. A woman who has been determined by the physician or qualified

practitioner treating her to be estrogen-deficient and at clinical risk for osteoporosis

based on her medical history and other findings.

2. An individual with vertebral abnormalities as demonstrated by an x-ray to be

indicative of osteoporosis, osteopenia, or vertebral fracture.

3. An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy

equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3

months.

4. An individual with primary hyperparathyroidism.

5. An individual being monitored to assess the response to or efficacy of an FDA approved osteoporosis drug therapy."

cms.gov/Regulations-and-Gui...

I believe we are covered by numerals 2 and 5 and possible 3 for those treated with Zytiga plus prednisone.

If one is being treated with Denosumab or zoledronic acid or similar, the DEXA is ordered for monitoring ongoing osteoporosis drug therapy.

I believe if a patient is on ADT and is not being treated with these drugs, the doctor may request the study to determine if these drugs are needed (baseline). Osteoporosis requires treatment and the diagnosis of osteoporosis is a T value less than -2.5 in a DEXA scan.

dhccpa in reply to tango6510 months ago

Thanks for that info. I have my first one since I've been on Medicare coming up next month. I had a previous one two years ago on private insurance.

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maley271110 months ago

From medicare.gov for bone mass measurement..........

covers this test once every 24 months (or more often if medically necessary) if you meet one of more of these conditions:

You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings.

Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.

You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.

You’ve been diagnosed with primary hyperparathyroidism.

You’re being monitored to see if your osteoporosis drug therapy is working.

It's not mentioned there, but I've read would be covered for men at age 70 or older?

BTW, are you age 60? Jus wondered, since Medicare would not be your coverage at that age?

GMan-62 in reply to maley271110 months ago

I’m on Social Security Disability. Once you have been receiving it for 2 years you are eligible for Medicare. I’m retired military and wanted to keep my Tricare insurance but once I became eligible for Medicare I had to take it or Tricare would cancel my Tricare insurance. Now Tricare acts as a gap insurance and covers what Medicare doesn’t. That is unless Medicare doesn’t cover it. Then they won’t.

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Grandpa410 months ago

10 years ago we stopped doing Dexascans because Medicare only reimbursed us $75 and we could not afford to do them. Can’t imagine it is $500 now. Guess it will end up being much cheaper. I also had a dexascan on Medicare without a problem. . Your oncologist should know the code. They do this all the time. I would explain the problem to them and ask them to resubmit with the right code.

kreg00110 months ago

77080-PN for the measurement. 77080-26 for the radiologist.

Maybe age related. I was 74 at the time.

anonymoose210 months ago

Did for me 3 times.

wilcoxsaw10 months ago

Mine is covered every 2 years by medicare

TEBozo10 months ago

Do you have a Medicare supplement policy?

GMan-62 in reply to TEBozo10 months ago

Yes and no. I’m retired military so when I became eligible for Medicare my military health insurance turned into something called Tricare for Life. It pays all my Medicare deductible and the 20 percent not covered by Medicare.

So far all of my treatments for PC have been covered by Medicare and Tricare for Life. I’ve had no out of pocket expenses. This DEXA scan is the firs time something has been declined. Hopefully the provider will be able to find the right codes to resubmit and get Medicare to cover it.

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spencoid210 months ago

i had a dexa scan that was covered by medicarethere may be standards for qualification for payment but everything i can find online says that medicare part b pays for it

GMan-6210 months ago

Thanks for all your responses. I’ll have to work with the provider to get them to resubmit and hopefully this will be resolved.

Teacherdude7210 months ago

Had several with Medicare..they were free.

Hidden10 months ago

Mine has for the past 7 yrs . They are given bi-annually ..

Hidden10 months ago

The dexa must be the cheapest of any scan that we get?