DEXA sooner that 2 years?

[RugbyVLS]

Has anyone who took ADT for 18 months gotten a DEXA reimbursed or denied by Medicare if the repeat scan was sooner than 2 years? It seems that if easily falls under "medically necessary" because of the damage ADT can do to bone health, but I can't get a straight answer from Medicare. Thanks for any input.

[Boywonder56]

i get mine evry year...

[dhccpa in reply to Boywonder56]

On Medicare? No trouble with coverage?

[Boywonder56 in reply to dhccpa]

yes...i have aetna advantage....its soc for met apc

[Boywonder56 in reply to Boywonder56]

and i have osteopena from eligard/ earleda....onc wants me on xgeva but ixnayed because of se......

[dhccpa in reply to Boywonder56]

I've had two, two years apart. My MO was uncertain Medicare would cover annually, even though I'm mHSPC. I guess we need to try it, as I had a slight regression between the two tests, but not yet a problem. Next scan 9/2024.

[mrscruffy]

Had 2 in 8 weeks. On an advantage plan

[London441]

This is a common problem. Keep after them. In the meantime, if you can afford it just pay for one yourself. Depending on where you live, they are usually $200 or less.

It’s information you don’t want to be without for any extended period while dealing with denials

[Mgtd]

just guessing but could it be a coding error? I had that issue with my SpaceOAR inserion. The urologist finally got it fixed.

[RugbyVLS]

Therein lies the problem . It is well documented that hypogonadism (treatment with ADT) leads to bone loss. After stopping ADT the only way to know if there is bone loss is with a DEXA (or maybe REMS ecolight, but that is not covered by insurance anyway). Medicare seems to focus on loss of estrogen as a reason to get more frequent DEXAs, but crickets when it comes to loss of testosterone.

[RugbyVLS]

Didn't get it yet since MO is unsure about insurance payment unless 2 years have passed since the baseline.

[garyjp9]

I agreed to a dexa scan one year after my first one, after my doctor said it would be covered. But it was not covered by either Medicare or my secondary insurance.

[RugbyVLS in reply to garyjp9]

Dang. Sorry to hear that.