Wellcare Dual Liberty (HMO D-SNP) (001): Bone Mass Measurement (Bone Density or BDM)

1 in 2 women over age 50 will break a bone because of osteoporosis. Osteoporosis does not have symptoms and is usually discovered after a fracture.

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Cost
$0
Prior Authorization Required
No
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. Obtain an order from your loved one's primary care provider or other specialist for bone mass measurement.

  2. Schedule the test at a network facility selected by the provider.

  3. Attend the appointment and complete the test.

  4. Following results, engage in follow-up recommendations and/or referrals.


For qualified individuals (generally, this means people at risk of losing bone mass or at risk of osteoporosis), the following services are covered every 24 months or more frequently if medically necessary: procedures to identify bone mass, detect bone loss, or determine bone quality, including a physician’s interpretation of the results.

Availability
Every 24 months (or more often if deemed medically necessary)

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Bone mass/density, or the structure and strength of our bones, affects our ability to move, bear weight, stand erect, and maintain muscle.  It is even associated with changes in blood cell production (red blood cells, white blood cells, and cells that respond to invasion and infection).  As we age, we are at higher risk of progressive bone density loss, which can lead to osteoporosis, especially in women.

A bone mineral density (BMD) test is used to measure bone mineral content and density, generally in the large bones (hips, femurs, spine), which gives us an idea of overall bone health.  This is done using X-rays, dual-energy X-ray absorptiometry (DEXA or DXA, which is the most popular), or a special CT scan that uses computer software to determine bone density of the hip or spine.  Ultrasound and blood tests may also be used.

Low bone density can have significant consequences, including increased risk for fractures and development of osteoporosis—a condition where low bone density causes holes inside the bone to widen and the outer walls, or cortex, of the bone to become thin, making bones more brittle and fragile.  The most serious complications of osteoporosis are spine and hip fractures, which can result in extensive surgeries and be life-limiting (shortening the lifespan) or even life-threatening (death).

Qualified individuals are those at risk of losing bone mass or at risk for osteoporosis: advanced age (80+), post-menopausal women (especially Caucasian and Asian), endocrine disorders (diabetes is the biggest), family history, poor diet and lack of calcium and vitamin D intake, long-term use of certain medications, and poor lifestyle habits (smoking and excessive drinking).  Covered services are procedures to identify bone mass and detect bone loss or determine bone quality, including a physician’s interpretation of the results.

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