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Bone densitometers

by Lauren Dubinsky, Senior Reporter | September 12, 2014
GE's Lunar iDXA
From the July 2014 issue of HealthCare Business News magazine

Dual-energy X-ray absorptiometry, known as DXA or DEXA, is the go-to bone density test for osteoporosis. However, since 2007, the Centers for Medicare and Medicaid has been slashing reimbursement for the test. The physician practice rate has now hit an all-time low and the hospital rate may soon come down to that level as well, but there are alliances fighting to bring that amount back to a sustainable level.

At the current reimbursement rate, practices offering DXA are losing money, causing many to discontinue the service.

Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million women and men aged 50 and older in the U.S., according to the International Osteoporosis Foundation.

Yet less and less people are getting the tests because of decreased access.

Organizations such as the International Society for Clinical Densitometry (ISCD) and the National Bone Health Alliance (NBHA) have made their pleas to CMS to raise reimbursement rates, but they claim the agency won’t listen. To make matters worse, there may be another round of cuts just around the corner.

How did we get here?
The cuts started in 2007 when the Federal Deficit Reduction Act cut all imaging services, taking DXA from $139 to $82 in one year. At the same time, CMS implemented the results of the review of reimbursement rates that it conducts every five years, and also implemented a new formula for calculating practice expense.

The majority of the DXA fee is related to the practice expense. When CMS began to phase in the new methodology for calculating practice expense, it caused the DXA rate to decline over the next five years, says Donna Fiorentino, legislative counsel for ISCD.

But with the introduction of the Affordable Care Act in 2010, there was some relief. Congress included a provision that partially restored DXA rates to $98. However, the payment relief expired on March 1, 2012 when Congress failed to include a provision that would have extended it for another year.

The reimbursement rate now stands at $49 with two other payment cuts on deck. “It’s just unbelievable what the numbers look like now,” says Fiorentino.

Starting in January, DXA and vertebral fracture assessment (VFA) may be bundled. VFA is a test that is performed to identify vertebral abnormalities and it gives the doctors another piece of information to diagnose osteoporosis.

Medicare has decided that if a doctor performs both DXA and VFA on the same day, those services will be bundled, meaning they will be billed together at a lower rate than if the two services were billed separately.

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