New Medicare DXA Reimbursement Rate!

Pam Flores Health Guide June 10, 2010
  • Recently the United State Congress passed the Health Care Reform Bill that will provide relief for the recent cuts made to the reimbursement rates Medicare (CMS) will pay for DXA scans.


    If you've been following this DXA story, because you have Medicare, or even if you don't, good news has arrived.  If you feel that this doesn't apply to you since you have private employee insurance, think again.  Many private insurers follow the recommendations made by CMS since it's the largest insurer in the United States, and many private insurance decisions are based on Medicare's rules. 


    Osteoporosis is an under-diagnosed disease, and only 13% of females with Medicare, who have osteoporosis, get a DXA scan each year.  This test is considered the Gold Standard for diagnosing osteoporosis and osteopenia; we need it because there is no other test that can provide this service.  Since the reimbursement cuts went into effect in 2007 and put DXA into jeopardy, that means that those with Medicare probably couldn't afford to have the scan, and many doctors stopped ordering it, due to this cut.    Since many Medicare beneficiaries live on a low fixed income, they constantly have to ask themselves, "Can I afford this?" and the answer is usually No.  The allowed reimbursement rate, since the cuts, has been around fifty dollars, for a test that costs three times that.  That might not sound like a lot of money to some, but if your monthly income is fixed, you just can't afford it.  If you have to have a test that costs approximately $150.00 or more and will only be reimbursed $50.00, then the balance is something you'll have to pay. 


    However a solution has been reached, but it's only temporary.  The passage of the Health Care Reform Bill will reinstate the reimbursement rate of approximately $98.00 for DXA and $27.00 dollars for a vertebral fracture assessment test for the next two years, and will be retroactive to January 1, 2010.  This means any DXA performed between January 2010 and May 31, 2010 will be paid at the above reimbursable rate instead of the greatly reduced 2007 rate.  If you had a scan during this period and paid the 2007 rate your doctor will have to reprocess the claim.  "The International Society of Clinical Densitometry (ISCD) is urging CMS to reprocess claims without requiring the provider to resubmit the original claims (ISCD June 2010)."


    To read more about HR 3590, The Patient Protection and Affordable Act, go to: www.ISCD.org/advocacy.


    Please let's not take this backwards step with a truly necessary preventative health scan that is so important to so many Americans.  We still don't know what will happen at the end of 2011, when this temporary relief ends, so be sure to follow this and make your voice heard!  

     

     

     

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