CPT code 76977, 77078, 77080, 77081 and G0130 - covred ICD 10 and benefit period

Bone Mass Measurements

HCPCS/CPT Codes

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 (eg, hips, pelvis, spine)

77080 – Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)

77081 – DXA, bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

G0130 – Single energy X-ray absorptiometry (SEXA) bone density study, 1 or more sites, appendicular skeleton (peripheral) (eg, radius, wrist, heel)


ICD-10-CM Codes

See https://www.cms.gov/Medicare/Coverage/ CoverageGenInfo/ICD10.html for individual Change Requests (CRs) and coding translations for ICD-10

Who Is Covered

Certain Medicare beneficiaries who fall into at least one of the following categories:

• Women determined by their physician or qualified non-physician practitioner (NPP) to be estrogen deficient and at clinical risk for osteoporosis;

• Individuals with vertebral abnormalities;

• Individuals getting (or expecting to get) glucocorticoid therapy for more than 3 months;

• Individuals with primary hyperparathyroidism; or

• Individuals being monitored to assess response to U.S. Food and Drug Administration (FDA)-approved osteoporosis drug therapy

Frequency

• Every 2 years; or

• More frequently if medically necessary Beneficiary Pays

• Copayment/coinsurance waived

• Deductible waived

Bone Density Scan CPT COde

Bone density scan is performed to check the density of bones. We use to   do do bone density scan to check oosteopenia  or osteoporosis present in bone. We  used CPT 77080 and 77081 in the year of 2014. CPT 77080 is  used to code for bone density scan of axial  bone   like hip, pelvis and  spine while 77081 was used to code axial bone like wrist, radius, heel etc.

Do and Don't for Bone density CPT code

Do not report 77080 in conjuction with 77085, 77086
Do not report 77085 cpt code  in conjunction with 77080, 77086
Do not report 77086 cpt code   in conjunction with 77080, 77085
While coding 77085 and 77081  together do remember to use modifier  XU with cpt code 77081. 
While coding 77081 and 77080 are bill together use modifier XU with CPT code 77080.


Insurance Carriers

Medicare covers bone mass measurements every 2years for "qualified" individuals considered to be at risk for osteoporssiis. Medicare beneficiary who meets the medical  indications for  one of the following categories:

1. an estrogen-defiicient, postmenopausal woman
2. an individual with verteebraal  abnormalities
3. an individual  with know primary hyperparathyrodism
4. some individuals reveiving steroid therapy
5. individuals receiving FDA-approved osteoporosis drug therapy