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.

Who Is Covered

Medicare Part B (Medical Insurance) covers this test once every 24 months (more often if medically necessary) for people 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

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

Note: This test helps to see if you're at risk for broken bones. Medicare only covers this test when it's ordered by a doctor or other qualified provider.

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)

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 (eg, hips, pelvis, spine)

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

77083 - Radiographic absorptiometry (e.g., photo densitometry, radiogrammetry), 1 or more sites

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

Under ICD-10-CM, the term “Osteopenia” is indexed to ICD-10-CM subcategory M85.8-Other specified disorders of bone density and structure, within the ICD-10-CM Alphabetic Index. The codes within this subcategory were inadvertently omitted from the CMS spreadsheet that accompanied CR 9252 containing the list of covered conditions and corresponding diagnosis codes. These are considered covered for NCD 150.3 indications.

Below is the list of ICD-10-CM diagnosis codes within subcategory M85.8- that providers may report as covered indications in addition to the current list provided in CR 9252 and its accompanying CMS spreadsheet.

M85.811 - Other specified disorders of bone density and structure, right shoulder

M85.812 - Other specified disorders of bone density and structure, left shoulder

M85.821 - Other specified disorders of bone density and structure, right upper arm

M85.822 - Other specified disorders of bone density and structure, left upper arm

M85.831 - Other specified disorders of bone density and structure, right forearm

M85.832 - Other specified disorders of bone density and structure, left forearm

M85.841 - Other specified disorders of bone density and structure, right hand

M85.842 - Other specified disorders of bone density and structure, left hand

M85.851 - Other specified disorders of bone density and structure, right thigh

M85.852 - Other specified disorders of bone density and structure, left thigh

M85.861 - Other specified disorders of bone density and structure, right lower leg

M85.862 - Other specified disorders of bone density and structure, left lower leg

M85.871 - Other specified disorders of bone density and structure, right ankle and foot

M85.872 - Other specified disorders of bone density and structure, left ankle and foot"

M85.88 - Other specified disorders of bone density and structure, other site"

M85.89 - Other specified disorders of bone density and structure, multiple sites"

Frequency

Every 2 years; or

More frequently if medically necessary

Medicare Beneficiary Pays

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

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

   Note: Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

References