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

[MoonRocket]

The real question is , are you having BMD issues?If you are, you GP should be able to get them earlier, especially if you are on bone strengthening med. If not, then every two years is probably sufficient. For me personally, I've been on ADT for 4 out of the last 5 years and I've had 2 DEXA scans that came normal. I'm due for my third DEXA scan in August. I am not on any bone strengthening agents and I don't take supplements regularly. My diet is my source of vitamins and minerals.

[RugbyVLS in reply to MoonRocket]

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.

[MoonRocket in reply to RugbyVLS]

I agree with you. I inferred you did have a DEXA scan, what were the findings? You don't say in your post.

[RugbyVLS in reply to MoonRocket]

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

[Mgtd]

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

[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.