Medicare Informatics - Medicare Informatics & Data Analysis in Cloud

Bone Mass (Bone Density) Measurements (NCD 150.3)

Medicare covers bone mass measurements to see if you’re at risk for broken bones due to osteoporosis. Osteoporosis is a disease in which your bones become weak and brittle. In general, the lower your bone density, the higher your risk for a fracture. Bone mass measurement results will help you and your doctor choose the best way to keep your bones strong.

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)

77085 – Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment

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

ICD-10-CM (ICD-9-CM) Codes

E21.0, E21.3, E23.0, E34.2, E89.40, E89.41, M80.08xA, M80.88xA, M84.58xA, M84.68xA, M85.9, M89.9, M94.9, N95.8, N95.9, Q55.4, Q78.0, S34.3xxA, Z78.0, Z79.3, Z79.51, Z79.52, Z79.811, Z79.83, Z87.310

NOTE: In addition to the specific ICD-10 codes listed above, some more specific codes from the following ICD-10 categories or subcategories may be used: E24, E28.3, M48, M81, M85.8 (codes for “unspecified” body parts excluded), Q96, S12, S14, S22, S24, S32.0, S32.1, S32.2, S34.1

NOTE: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual Change Requests (CRs) and the specific ICD-10-CM codes Medicare covers for this service, and contact your Medicare Administrative Contractor (MAC) for guidance.

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 (based on her medical history and other findings);
~~Individuals with vertebral abnormalities;~~
A person taking prednisone or steroid-type drugs or is planning to begin this treatment;
~~Individuals getting (or expecting to get) glucocorticoid therapy for more than 3 months;~~
A person taking prednisone or steroid-type drugs or is planning to begin this treatment;
A person who has been diagnosed with primary hyperparathyroidism; or
~~Individuals being monitored to assess response to U.S. Food and Drug Administration (FDA)-approved osteoporosis drug therapy~~
A person who is being monitored to see if their osteoporosis drug therapy is working

Frequency

Every 2 years; or
More frequently if medically necessary

NOTE: Refer to the current codes in the ICD-10 Conversion/Coding Infrastructure Revisions to National Coverage Determinations (NCDs)--3rd Maintenance for reporting frequency requirements with respect to specific ICD-10 codes.

Beneficiary Pays

You pay nothing for this screening if the doctor or other qualified health care provider accepts assignment.

Copayment/coinsurance waived
Deductible waived

Other Notes

Do not report 77080 with 77085 or 77086. Do not report 77085 with 77080 or 77086. Do not report 77086 with 77080 or 77085. Medicare does not cover 77086 for this service.
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.
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.