Bone Mass Measurements
Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). People are at risk for fractures because of osteoporosis. Osteoporosis is a disease in which your bones become weak. In general, the lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong.
How often is it covered?
Once every 24 months (more often if medically necessary)
For whom?
All people with Medicare who are at risk for osteoporosis.
Your costs if you have Original Medicare
Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.
Are you at risk for osteoporosis?
Your risk for osteoporosis increases if you…
are age 50 or older
are a woman
have a family history of broken bones
have a personal history of broken bones
are White or Asian
are small-boned
have low body weight (less than about 127 pounds)
smoke or drink a lot
have a low-calcium diet
Showing posts with label Bone mass measurement. Show all posts
Showing posts with label Bone mass measurement. Show all posts
billing CPT 77078,77079,77080,77081,76977 & G0130 - bone mass measuremnet
OTHER MEDICARE PREVENTIVE SERVICES
Following are brief descriptions of other preventive services covered by Medicare and sometimes provided by obstetrician/gynecologists.
Bone Mass Measurements
Medicare covers bone mass measurements every two years for qualified individuals. The patient is responsible for meeting her Medicare Part B deductible and for her 20% co-payment.
A “qualified individual” meets at least one of these medical indications:
• Estrogen-deficient and at clinical risk for osteoporosis
• Vertebral abnormalities as demonstrated by an x-ray
• Receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5.0 mg of prednisone or greater, per day, for more than 3 months
• Has a diagnosis of primary hyperparathyroidism
• Being monitored to assess the response to or efficacy of an FDA – approved osteoporosis drug therapy
Medicare may pay for more frequent screenings when medically necessary. Examples include, but are not limited to, the following medical circumstances:
• Monitoring beneficiaries on long-term (more than 3 months) glucocorticoid (steroid) therapy
• Confirming baseline BMMs to permit monitoring of beneficiaries in the future
Procedure Codes
Medicare allows the physician to choose the screening test. As of January 1, 2007, the CPT/HCPCS coding options are:
77078 Computed tomography, bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77079 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77080 Dual energy x-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77081 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77083 Radiographic absorptiometry (photodensitometry, radiogrammetry), one or more sites
76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method
G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites, appendicular skeleton (peripheral; e.g., radius, wrist, heel)
Diagnosis Codes
Local carriers determine the ICD-9-CM diagnostic codes that they will accept as supporting these indications. The test must be ordered by a physician or a qualified nonphysician practitioner who is treating the patient. Qualified nonphysician practitioners include physician assistants, nurse practitioners, clinical nurse specialists, and nurse-midwives. The test results must be required as part of the patient’s evaluation and/or formulation of a treatment plan.
Following are brief descriptions of other preventive services covered by Medicare and sometimes provided by obstetrician/gynecologists.
Bone Mass Measurements
Medicare covers bone mass measurements every two years for qualified individuals. The patient is responsible for meeting her Medicare Part B deductible and for her 20% co-payment.
A “qualified individual” meets at least one of these medical indications:
• Estrogen-deficient and at clinical risk for osteoporosis
• Vertebral abnormalities as demonstrated by an x-ray
• Receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5.0 mg of prednisone or greater, per day, for more than 3 months
• Has a diagnosis of primary hyperparathyroidism
• Being monitored to assess the response to or efficacy of an FDA – approved osteoporosis drug therapy
Medicare may pay for more frequent screenings when medically necessary. Examples include, but are not limited to, the following medical circumstances:
• Monitoring beneficiaries on long-term (more than 3 months) glucocorticoid (steroid) therapy
• Confirming baseline BMMs to permit monitoring of beneficiaries in the future
Procedure Codes
Medicare allows the physician to choose the screening test. As of January 1, 2007, the CPT/HCPCS coding options are:
77078 Computed tomography, bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77079 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77080 Dual energy x-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77081 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77083 Radiographic absorptiometry (photodensitometry, radiogrammetry), one or more sites
76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method
G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites, appendicular skeleton (peripheral; e.g., radius, wrist, heel)
Diagnosis Codes
Local carriers determine the ICD-9-CM diagnostic codes that they will accept as supporting these indications. The test must be ordered by a physician or a qualified nonphysician practitioner who is treating the patient. Qualified nonphysician practitioners include physician assistants, nurse practitioners, clinical nurse specialists, and nurse-midwives. The test results must be required as part of the patient’s evaluation and/or formulation of a treatment plan.
Medicare policy of bone mass measurement billing
Bone Mass Measurement for Medicare
The services described in Oxford policies are subject to the terms, conditions and limitations of the Member's contract or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage enrollees. Oxford reserves the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies as well as SecureHorizons and EvercareCertain policies may not be applicable to Self-Funded Members and certain insured products. Refer to the Member's plan of benefits or Certificate of Coverage to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the Member’s plan of benefits or Certificate of Coverage, the plan of benefits or Certificate of Coverage will govern.
Policy #: RADIOLOGY 007.14 T0
Coverage Statement: Policy is applicable to:
- AARP MedicareComplete, Evercare Plan DH and SecureHorizons MedicareComplete, including Group Retiree Plans underwritten by Oxford Health Plans (NY/NJ/CT), Inc. (CMS Contract Numbers: H0752, H3107 and H3307)
| Benefit Type | General benefits package |
| Referral Required (Does not apply to non-gatekeeper products) | No |
| Authorization (Precertification always required for inpatient admission) | No |
| Precertification with MD Review | No |
| Site(s) of Service (If not listed, MD Review required) | Outpatient, Office |
Bone mass measurement (BMM) studies are radiologic, radioisotopic or other procedures that meet all of the following conditions:
- quantify bone mineral density, detect bone loss or determine bone quality;
- are performed with either a bone densitometer (other than single-photon or dual-photon absorptiometry) or a bone sonometer system that has been cleared or approved for marketing for BMM by the Food and Drug Administration (FDA);
- include a physician's interpretation of the results.
- dual energy x-ray absorptiometry (DXA)
- radiographic absorptiometry (RA)
- bone sonometry (ultrasound)
- single energy x-ray absorptiometry (SEXA)
- quantitative computed tomography (QCT)
when oxford insurance will cover bone mass measurement
Oxford will cover a bone mass measurement test when it meets all of the following criteria:
- It is performed with one of the covered tests listed below.
- dual energy x-ray absorptiometry (DXA)
- radiographic absorptiometry (RA)
- bone sonometry (ultrasound)
- single energy x-ray absorptiometry (SEXA)
- quantitative computed tomography (QCT)
- It is performed on a qualified individual for the purpose of identifying bone mass, detecting bone loss or determining bone quality. The term "qualified individual" means an individual who meets the medical indications for at least one of the five categories listed below:
- A woman who has been determined by the physician or a qualified nonphysician practitioner treating her to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other findings;
- An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass), or vertebral fracture;
- An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of prednisone, or greater, per day, for more than three (3) months;
- An individual with primary hyperparathyroidism;
- An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy.
- It is furnished by a qualified supplier or provider of such services under at least the general level of supervision of a physician as defined in 42 CFR 410.32(b).
- The test is ordered by the individual's physician or qualified non-physician practitioner, who is treating the beneficiary following an evaluation of the need for the measurement, including a determination as to the medically appropriate measurement to be used for the individual, and who uses the results in the management of the patient.
- The test is reasonable and necessary for diagnosing, treating, or monitoring of a "qualified individual" as defined above in #2. Monitoring is defined as subsequent testing in patients on FDA-approved drug therapy.
- Oxford may cover a bone mass measurement for a beneficiary once every 2 years (if at least 23 months have passed since the month the last bone mass measurement was performed).
- For conditions specified, Oxford will cover a bone mass measurement for a qualified individual more frequently than every two years, if medically necessary for the diagnosis or treatment of the individual and if related to the condition listed. In these instances reimbursement may be made for tests performed after eleven months have elapsed since the previous bone mass measurement test. Examples include, but are not limited to, the following medical circumstance:
- Monitoring beneficiaries on long-term glucocorticoid (≥ 5 mg/day) therapy of more than 3 months (patients must be on glucocorticoids for greater than three months duration, but BMM monitoring is at yearly intervals).
- Confirming baseline BMMs to permit monitoring of beneficiaries in the future.
- In addition, bone mass measurement for the following may be reimbursed more frequently than every two years:
- Follow up bone mineral density testing to assess FDA-approved osteoporosis drug therapy until a response to such therapy has been documented over time.
- A confirmatory baseline BMM is only covered when it is performed with a dual-energy x-ray absorptiometry system (axial skeleton) and the initial BMM was not performed by a dual-energy x-ray absorptiometry system (axial skeleton). A confirmatory baseline BMM is not covered if the initial BMM was performed by a dual-energy x-ray absorptiometry system (axial skeleton).
- For an individual being monitored to assess the response to, or efficacy of, an FDA-approved osteoporosis drug therapy, the test is only covered if it is performed with a dual-energy x-ray absorptiometry system (axial skeleton).
- The test must include a physician's interpretation of the results.
- Since not every woman who has been prescribed estrogen replacement therapy (ERT) may be receiving an "adequate" dose of the therapy, the fact that a woman is receiving ERT should not preclude her treating physician/other qualified non-physician practitioner from ordering a bone mass measurement test for her. If a bone mass measurement test is ordered for a woman following a careful evaluation of her medical need, it is expected that the ordering/treating physician/qualified non-physician practitioner will document, why he or she believes that the woman is estrogen deficient and at clinical risk for osteoporosis.
Limitations for bone mass measurement
Limitations for bone mass measurement (BMM)
- Tests not ordered by the physician/qualified non-physician practitioner, who is treating the individual, are not reasonable and necessary.
- Oxford's reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied (e.g., if the spine and hip are studied, CPT code 77080 should be billed only once).
- It is not medically necessary to perform more than one type of BMM test in any individual, unless a DXA confirmatory test is performed as a baseline for future monitoring (see Indications #7 and #8).
- It is not medically necessary to have both peripheral and axial BMM tests performed on the same day.
- Oxford will not reimburse BMM tests performed by a second provider, when a test has already been performed within the defined coverage period, as stated above, unless as confirmatory testing for future monitoring. Individuals must authorize providers to obtain prior test results. If unsuccessful efforts to obtain prior test results from another provider are documented, new tests may be considered for reimbursement.
- Single and dual photon absorptiometry, CPT code 78350 and 78351, are non-covered services.
- Bone mass measurement is not covered and will be denied when performed by a portable x-ray supplier. Transportation charges for BMM testing will be denied
- Bone mass measurement tests provided without an accompanying interpretation and report, as part of the test, will be denied as not medically necessary.
- Bone mass measurement tests will be denied as not medically necessary if performed by a non-physician practitioner.
- CPT code 77082 is considered by Medicare to represent vertebral fracture assessment only. Because code 77082 does not represent a bone density study, it should NOT be billed for screening. This code may be billed when medically necessary (i.e. when a vertebral fracture assessment is required). Symptoms should be present and documented, and it should be anticipated that the results of the test will be used in the management of the patient.
cpt code 76977,77078,77079,77081, g0130 with covered dx
Payment Guidelines for BMM:
Applicable CPT Codes
Applicable ICD-9 Diagnosis Codes
Non-Reimbursable CPT Codes
Applicable CPT Codes
| Code | 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) |
| 77079 | Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) |
| 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) |
| 77083 | Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), 1 or more sites |
| G0130 | Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) |
| Code | Description |
| 241.0 | Nontoxic uninodular goiter |
| 246.9 | Unspecified disorder of thyroid |
| 252.00 | Hyperparathyroidism, unspecified |
| 252.01 | Primary hyperparathyroidism |
| 252.02 | Secondary hyperparathyroidism, non-renal |
| 252.08 | Other hyperparathyroidism |
| 255.0 | Cushing's syndrome |
| 256.2 | Postablative ovarian failure |
| 256.31 | Premature menopause |
| 256.39 | Other ovarian failure |
| 259.3 | Ectopic hormone secretion, not elsewhere classified |
| 627.0 | Premenopausal menorrhagia |
| 627.1 | Postmenopausal bleeding |
| 627.2 | Symptomatic menopausal or female climacteric states |
| 627.3 | Postmenopausal atrophic vaginitis |
| 627.4 | Symptomatic states associated with artificial menopause |
| 627.8 | Other specified menopausal and postmenopausal disorder |
| 627.9 | Unspecified menopausal and postmenopausal disorder |
| 733.00 | Unspecified osteoporosis |
| 733.01 | Senile osteoporosis |
| 733.02 | Idiopathic osteoporosis |
| 733.03 | Disuse osteoporosis |
| 733.09 | Other osteoporosis |
| 733.12 | Pathologic fracture of distal radius and ulna |
| 733.13 | Pathologic fracture of vertebrae |
| 733.14 | Pathologic fracture of neck of femur |
| 733.15 | Pathologic fracture of other specified part of femur |
| 733.16 | Pathologic fracture of tibia and fibula |
| 733.19 | Pathologic fracture of other specified site |
| 733.90 | Disorder of bone and cartilage, unspecified |
| 733.93 | Stress fracture of tibia or fibula |
| 733.94 | Stress fracture of the metatarsals |
| 733.95 | Stress fracture of other bone |
| 756.51 | Osteogenesis imperfecta |
| 758.6 | Gonadal dysgenesis |
| 781.91 | Loss of height |
| 793.7 | Nonspecific abnormal findings on radiological and other examination of musculoskeletal system |
| 805.00 | Closed fracture of cervical vertebra, unspecified level without mention of spinal cord injury |
| 805.01 | Closed fracture of first cervical vertebra without mention of spinal cord injury |
| 805.02 | Closed fracture of second cervical vertebra without mention of spinal cord injury |
| 805.03 | Closed fracture of third cervical vertebra without mention of spinal cord injury |
| 805.04 | Closed fracture of fourth cervical vertebra without mention of spinal cord injury |
| 805.05 | Closed fracture of fifth cervical vertebra without mention of spinal cord injury |
| 805.06 | Closed fracture of sixth cervical vertebra without mention of spinal cord injury |
| 805.07 | Closed fracture of seventh cervical vertebra without mention of spinal cord injury |
| 805.08 | Closed fracture of multiple cervical vertebrae without mention of spinal cord injury |
| 805.1 | Open fracture of cervical vertebra without mention of spinal cord injury |
| 805.10 | Open fracture of cervical vertebra, unspecified level without mention of spinal cord injury |
| 805.11 | Open fracture of first cervical vertebra without mention of spinal cord injury |
| 805.12 | Open fracture of second cervical vertebra without mention of spinal cord injury |
| 805.13 | Open fracture of third cervical vertebra without mention of spinal cord injury |
| 805.14 | Open fracture of fourth cervical vertebra without mention of spinal cord injury |
| 805.15 | Open fracture of fifth cervical vertebra without mention of spinal cord injury |
| 805.16 | Open fracture of sixth cervical vertebra without mention of spinal cord injury |
| 805.17 | Open fracture of seventh cervical vertebra without mention of spinal cord injury |
| 805.18 | Open fracture of multiple cervical vertebrae without mention of spinal cord injury |
| 805.2 | Closed fracture of dorsal (thoracic) vertebra without mention of spinal cord injury |
| 805.3 | Open fracture of dorsal (thoracic) vertebra without mention of spinal cord injury |
| 805.4 | Closed fracture of lumbar vertebra without mention of spinal cord injury |
| 805.5 | Open fracture of lumbar vertebra without mention of spinal cord injury |
| 805.6 | Closed fracture of sacrum and coccyx without mention of spinal cord injury |
| 805.7 | Open fracture of sacrum and coccyx without mention of spinal cord injury |
| 805.8 | Closed fracture of unspecified part of vertebral column without mention of spinal cord injury |
| 805.9 | Open fracture of unspecified part of vertebral column without mention of spinal cord injury |
| 806.00 | Closed fracture of C1-C4 level with unspecified spinal cord injury |
| 806.01 | Closed fracture of C1-C4 level with complete lesion of cord |
| 806.02 | Closed fracture of C1-C4 level with anterior cord syndrome |
| 806.03 | Closed fracture of C1-C4 level with central cord syndrome |
| 806.04 | Closed fracture of C1-C4 level with other specified spinal cord injury |
| 806.05 | Closed fracture of C5-C7 level with unspecified spinal cord injury |
| 806.06 | Closed fracture of C5-C7 level with complete lesion of cord |
| 806.07 | Closed fracture of C5-C7 level with anterior cord syndrome |
| 806.08 | Closed fracture of C5-C7 level with central cord syndrome |
| 806.09 | Closed fracture of C5-C7 level with other specified spinal cord injury |
| 806.10 | Open fracture of C1-C4 level with unspecified spinal cord injury |
| 806.11 | Open fracture of C1-C4 level with complete lesion of cord |
| 806.12 | Open fracture of C1-C4 level with anterior cord syndrome |
| 806.13 | Open fracture of C1-C4 level with central cord syndrome |
| 806.14 | Open fracture of C1-C4 level with other specified spinal cord injury |
| 806.15 | Open fracture of C5-C7 level with unspecified spinal cord injury |
| 806.16 | Open fracture of C5-C7 level with complete lesion of cord |
| 806.17 | Open fracture of C5-C7 level with anterior cord syndrome |
| 806.18 | Open fracture of C5-C7 level with central cord syndrome |
| 806.19 | Open fracture of C5-C7 level with other specified spinal cord injury |
| 806.20 | Closed fracture of T1-T6 level with unspecified spinal cord injury |
| 806.21 | Closed fracture of T1-T6 level with complete lesion of cord |
| 806.22 | Closed fracture of T1-T6 level with anterior cord syndrome |
| 806.23 | Closed fracture of T1-T6 level with central cord syndrome |
| 806.24 | Closed fracture of T1-T6 level with other specified spinal cord injury |
| 806.25 | Closed fracture of T7-T12 level with unspecified spinal cord injury |
| 806.26 | Closed fracture of T7-T12 level with complete lesion of cord |
| 806.27 | Closed fracture of T7-T12 level with anterior cord syndrome |
| 806.28 | Closed fracture of T7-T12 level with central cord syndrome |
| 806.29 | Closed fracture of T7-T12 level with other specified spinal cord injury |
| 806.30 | Open fracture of T1-T6 level with unspecified spinal cord injury |
| 806.31 | Open fracture of T1-T6 level with complete lesion of cord |
| 806.32 | Open fracture of T1-T6 level with anterior cord syndrome |
| 806.33 | Open fracture of T1-T6 level with central cord syndrome |
| 806.34 | Open fracture of T1-T6 level with other specified spinal cord injury |
| 806.35 | Open fracture of T7-T12 level with unspecified spinal cord injury |
| 806.36 | Open fracture of T7-T12 level with complete lesion of cord |
| 806.37 | Open fracture of T7-T12 level with anterior cord syndrome |
| 806.38 | Open fracture of T7-T12 level with central cord syndrome |
| 806.39 | Open fracture of T7-T12 level with other specified spinal cord injury |
| 806.4 | Closed fracture of lumbar spine with spinal cord injury |
| 806.5 | Open fracture of lumbar spine with spinal cord injury |
| 806.60 | Closed fracture of sacrum and coccyx with unspecified spinal cord injury |
| 806.61 | Closed fracture of sacrum and coccyx with complete cauda equina lesion |
| 806.62 | Closed fracture of sacrum and coccyx with other cauda equina injury |
| 806.69 | Closed fracture of sacrum and coccyx with other spinal cord injury |
| 806.70 | Open fracture of sacrum and coccyx with unspecified spinal cord injury |
| 806.71 | Open fracture of sacrum and coccyx with complete cauda equina lesion |
| 806.72 | Open fracture of sacrum and coccyx with other cauda equina injury |
| 806.79 | Open fracture of sacrum and coccyx with other spinal cord injury |
| 806.8 | Closed fracture of unspecified vertebra with spinal cord injury |
| 806.9 | Open fracture of unspecified vertebra with spinal cord injury |
| E932.0 | Adrenal cortical steroids causing adverse effect in therapeutic use |
| V45.77 | Acquired absence of organ, genital organs |
| V49.81 | Asymptomatic postmenopausal status (age-related) (natural) |
| V58.65 | Long-term (current) use of steroids |
| V58.69 | Encounter for long-term (current) use of other medications |
| V67.51 | Follow-up examination following completed treatment with high-risk medications, not elsewhere classified |
| Code | Description |
| 78350 | Bone density (bone mineral content) study, 1 or more sites, single photon absorptiometry |
| 78351 | Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry, 1 or more sites |
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