I work at a cancer center & it is very frustating that we are unable to order this scan for people who are getting treating for cancer (ex Arimedex) that cause osteoprosis /osteopenia. And this is not covered within 2 period..
moshuff--Hi and welcome.
I am on Medicare, also taking Fermara for the past 2 yrs. Must take it for 5 yrs. My oncologist has submitted a letter to my DEXA office that I must have a scan every year, not evry 2 yrs---and Medicare pays for it. I think that is all that is required. I do not know how other insurance companies will respond, but I'm sure a large number of us are on Medicare. I'm also on Prediisone for OA and I take Fosamax---about 7 yrs now, so I really need the DEXA every year. Hope this is of some help. Bev.
Your right most pt do have Medicare. What state do you live in???
Hey Bev ,
Thanx for responding . I think because you are on the Prednisone is a factor. I also was wandering what state you are located.
Hi again, first I live on the South Shore of Long Island in NY.
I had surgery for breast cancer in Nov of 06, finished Mammosite radiation in Dec 06, and then started Femara. It was then that my oncologist ordered yearly DEXA tests because the Femara can lead to osteoporosis---which I already have !!! I've been on Foxamax for about 7 yrs--with no digestive problems. it is only recently that I've been on Prednisone for OA--Sept 08. Originally thought it to be RA but thankfully it's OA---which in my case stands for Old Age. LOL I was 77 Oct 5th.
All for now. Keep in touch. Bev.
Hi Bev,
I really do appreciate you responding to my questions. We are in south Jersey it has been just recently (this year)that the facility that we use are not getting paid for Dexa scans . And having pt 's fill out a ABN form making the pt responsible for payment . They go by Medicare guidlines & from what I understand they do not cover it for the reasons given to you previously. I feel we may be missing something ....Maureen
Hi moshuff: If the facility you use goes by MC standards, then a patient should be able to get a dxa more often than 24 mos if it's considered medically necessary. Do you have a copy of the NCD manual? Look up bone density scans and the explanation on coverage. Usually MC pays every 24 mos, but if there is a medical reason to do it sooner, then the dr would have to write a letter of medical necessity, to get it covered. It works the same with mammo's and paps. MC pays for these every 24 mos unless the patient is considered high risk, or it's medically necessary then they (MC) are suppose to pay for the test more often than every 24 mos.
Good Luck
Hi Maureen,
We are in neighboring states but two of my kids live in NJ. One in Basking Ridge and the other in Linwood--near Atlantic City. So we are in NJ often. Also a very dear friend just moved from Cherry Hill. She had lived there for some 50 yrs on Ridgestone Ridge. Small world. Bev.
I get reimbursement by using V5865 for steroid use, & V6759, which is following other treatment. You could also use V6751, which would be completed trtmt w/ high risk medication or V662 - following chemotherapy; V661 - following radiation therapy. I know at our facility, patients are often given steroids as part of their cancer trtmts, so the V5865 is okay. These codes allow the patient to have a scan every year.
Hope that helps some.
Thank you I will foreward this info on..Moshuff
Hi Maureen,
Haven't heard from you recently and was wondering how things are going for you. Have you had any success in getting your DEXA tests paid for?
Where in south Jersey do you live?
Talk to you later. Bev.
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