Medicare reimbursement for DXA tests restored

Dec 27 2009

Passage of health care reform legislation today in the U.S. Senate will help provide older Americans with easier access to quality osteoporosis diagnosis, prevention and treatment services. Included in the Senate health reform bill is a provision restoring Medicare reimbursement for dual energy X-ray absorptiometry (DXA), the leading diagnostic tool for the early detection and management of osteoporosis. Recent Medicare cuts for DXA tests jeopardized patient access to this important preventive healthcare service. Without congressional action, many doctors would be forced to discontinue providing DXA services in their offices as reimbursement is now substantially lower than the cost of performing the test.

In 2002, the United States Preventive Services Task Force recommended that all women aged 65 and older be screened for osteoporosis with a DXA study. The inclusion of DXA in the bill is a perfect example of a renewed focus on prevention; several studies have shown that increased DXA testing and treatment result in a dramatic decrease in fractures and related health care costs.

A coalition of patient and physician organizations have been working for more than three years toward a legislative and regulatory solution to the Medicare payment cuts for DXA services performed in physicians' offices. According to the coalition, passage of this legislation brings the country one step closer to ensuring that patients will be able to continue to receive this vital diagnostic test. The coalition stresses that having access to DXA services in a doctor's office close to home is especially critical to those living in rural and underserved areas.

The approved provision was originally drafted by Senator Blanche Lincoln (D-AR) and included in the Senate Finance Committee health reform bill. It was later incorporated into the Senate health reform package. Specifically, the provision sets Medicare payments for DXA services performed in a physician's office at 70 percent of the 2006 level for two years while the Institute of Medicine completes a study on the impact of the payment cuts on patient access.

Coalition members initiated discussions with Senator Lincoln's office in January of 2009 to highlight the importance of maintaining patient access to DXA services, particularly in rural areas such as Arkansas. A concerted effort by the coalition resulted in bipartisan support for the DXA reimbursement bill from members of Congress.

The coalition is pleased that Congress is taking steps to increase bone health awareness and prevent fractures. With passage of this legislation, patients will continue to have access to optimal osteoporosis care as both primary and specialty healthcare providers will continue to have first-hand access to DXA testing thereby allowing them to determine the most effective treatment and prevention options.

The coalition of patient and physician groups includes: American Association of Clinical Endocrinologists (AACE); American College of Rheumatology (ACR); The Endocrine Society (TES); and International Society for Clinical Densitometry (ISCD).