Procedure code and Description
• 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method
• 77078: Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (e.g., hips, pelvis, spine)
• 77080: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
• 77081: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites;appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
Coding and Billing Guidelines
For osteoporosis, osteopenia, and vertebral fracture, use the corresponding ICD-9-CM code(s) from the “ICD-9- CM Codes That Support Medical Necessity” section to code the vertebral abnormality. Use diagnosis code 733.90 to indicate osteopenia,(only when billing 77080-DXA) when used to follow treatment with FDA approved osteoporosis medications. For osteoporosis, osteopenia, and vertebral fracture, the medical record must include an x-ray or other study report of the spine that demonstrates the applicable vertebral abnormality(ies)
CPT code 77082 is considered by Medicare to represent vertebral fracture assessment only. Because code 77082 does not represent a BONE density study, when a BONE density study with vertebral fracture assessment is performed, bill the code for the appropriate BONE density study (e.g., 77080) plus code 77082.
Claims for global BONE density measurement (77078, 77080, 77081, and G0130) should indicate one of the following payable places of service for reimbursement: office (11), mobile (15), and independent clinic (49).
When billing for the technical component only, a TC modifier must be appended to the CPT/HCPCS code. Claims for the technical component only (77078/TC, 77080/TC, 77081/TC and G0130/TC) should indicate one of the following payable places of service for reimbursement: office (11), mobile (15), independent clinic (49), federally qualified health centers (50) and rural health clinics (72).
When billing for the professional component only, a 26 modifier must be appended to the CPT/HCPCS code. Claims for the professional component only (77078/26, 77080/26, 77081/26 and G0130/26) should indicate one of the following payable places of service for reimbursement: office (11), mobile (15), inpatient hospital (21), outpatient hospital (22), and independent clinic (49).
Group 1 Paragraph: Note: ICD-10 codes must be coded to the highest level of specificity. When 77078, 77080, 77081, 77085, 76977 or G0130 is done as an initial diagnostic test that determines a diagnosis of E24.0 – E24.9, code as a secondary diagnosis the reason for the bone mass density test. Patients who qualify by statute for osteoporosis screening may be evaluated by studies that are characterized by CPT codes 77078, 77080, 77081, 77085, 76977, and G0130. The following is a list of ICD-10-CM codes that support the medical necessity of osteoporosis screening.
Group 2 Paragraph: For use with CPT Codes 77080 (DXA) and 77085 (DXA and vertebral fracture assessment). Once the diagnosis of osteoporosis has been established, the effectiveness of treatment can ONLY be monitored using a dual energy x-ray absorptiometry.
Any of the following bone mineral density measurement testing methods is considered medically necessary:
• peripheral ultrasound (CPT® 76977)
• central dual x-ray absorptiometry (DXA) (CPT® 77080)
• peripheral DXA (CPT® 77081)
• peripheral single energy x-ray absorptiometry (HCPCS code G0130)
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton
(eg, hips, pelvis, spine)
Reimbursement and payment details
Contractors will pay claims for screening tests when coded as follows:
Contains CPT procedure code 77078, 77079, 77080, 77081, 77083, 76977 or G0130, and Contains a valid diagnosis code indicating the reason for the test is postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy. Contractors are to maintain local lists of valid codes for the benefit’s screening categories.
Contractors will pay claims for monitoring tests when coded as follows:
Contains CPT procedure code 77080 or 77085, and Contains 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 as the ICD-9-CM diagnosis code or M81.0, M81.8, M81.6 or M94.9 as the ICD-10-CM diagnosis code.
Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
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