Bone mass measurements
Medicare covers bone mass measurements for certain Medicare beneficiaries who fall into at least one of the following categories:
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Women determined by their physician or qualified nonphysician practitioner (NPP) to be estrogen deficient and at clinical risk for osteoporosis
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Individuals with vertebral abnormalities
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Individuals getting (or expecting to get) glucocorticoid therapy for more than three months
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Individuals with primary hyperparathyroidism
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Individuals being monitored to assess response to U.S. Food and Drug Administration (FDA)-approved osteoporosis drug therapy
HCPCS/CPT codes
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76977 – Ultrasound bone density measurement and interpretation, peripheral site, any method
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77078 – Computed tomography, bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
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77080 – Dual-energy X-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
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77081 – DEXA, bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
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G0130 – Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites, appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
Frequency
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Every two years:
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More frequently if medically necessary
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Notes
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Do not report 77080 with 77085 or 77086
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Do not report 77085 with 77080 or 77086
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Do not report 77086 with 77080 or 77085
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Medicare does not cover 77086 for this service.
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When coding 77085 and 77081 together, attach modifier –XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 77081 to bypass Correct Coding Initiative edit
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When coding 77080 and 77081 together, attach modifier –XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 77080
Deductible and coinsurance are waived for this service.
References