Bone Mass Measurement Awareness and Screening

According to the Centers for Medicare & Medicaid Services (CMS), Office of Minority Health, Osteoporosis is a chronic condition that weakens bones, especially those in the neck, back, and hips. It is considered a silent disease because an individual frequently does not know he or she has it until they break a bone. The early stage of osteoporosis is marked by low bone density which can be identified by bone mass measurements and managed with lifestyle changes. In the United States in 2017–2018, an estimated 12.6 percent adults aged 50 and over had osteoporosis, and the prevalence was higher in women than men and higher among adults aged 65 and over than adults aged 50 to 64.

CMS says according to a 2021 report published on Bone Health & Osteoporosis Foundation site, osteoporotic fractures exact a huge human and economic toll. 

• Approximately 1.8 million Medicare beneficiaries suffered approximately 2.1 million osteoporotic fractures in 2016
• Total estimated allowed medical cost to Medicare FFS in the six-month period following subsequent fractures that were suffered up to three years following an initial fracture in 2016, was $5.7 billion. Some suggest this amount may be even higher. 
• Preventing 20 percent of subsequent fractures in Medicare FFS could have saved $1.1 billion in 2016

There were/are substantial racial/ethnic disparities in fracture incidence and care. The report linked by CMS found that “fracture rates varied substantially by race/ethnicity.” The analysis shows that:

• North American natives suffered fractures at a rate 20 percent higher than the national average
• While suffering fewer initial fractures and subsequent fractures, black Medicare FFS beneficiaries have lower screening rates and a higher hospitalization rate following fractures. Forty-five percent were hospitalized within seven days of the fracture, compared to national average of 42 percent. Twenty-two percent of Black beneficiaries died within 12 months of an initial osteoporotic fracture, exceeding the national average of 19 percent.  Milliman Report_BHOF (squarespace.com)

Medicare pays for high-quality bone density testing to identify those who are at risk of bone fractures, allowing for early and effective preventive steps and interventions. However, only nine percent of women who suffer a fracture are screened for osteoporosis within six months of a new fracture. In the last several years the osteoporosis diagnosis of older women has declined by an estimated 18 percent.

Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut subsequent fractures by about half. But about 80 percent go untreated, even after a fracture. 

Bone Mass Measurement
National Coverage Determination 150.3, also known as Bone (Mineral) Density Studies.

CPT® and HCPCS Codes 

• CPT® code 76977 — Ultrasound bone density measurement and interpretation, peripheral site(s), any method
• CPT® code 77078 — Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (e.g., hips, pelvis, spine)
• CPT® code 77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
• CPT® code 77081 — Dual-energy DXA, bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
• CPT® code 77085 — Dual-energy DXA, bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine), including vertebral fracture assessment
• HCPCS code G0130 — Single-energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
   

ICD-10 Codes
Find the most current list of ICD-10 codes in the 150.3 Bone (Mineral) Density Studies coding file.

Notes

• You may use the ICD-10 codes in the coding file or more specific codes from these ICD-10 categories or subcategories: 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.
• Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 webpage. Follow the Palmetto GBA website for more information.
   

Medicare Covers
Patients with Medicare Part B who meet at least one of these criteria:

• Women whose physician or qualified practitioner determines them estrogen-deficient and at clinical osteoporosis risk
• People with vertebral abnormalities
• People getting (or expecting to get) glucocorticoid therapy for more than three months
• People with primary hyperparathyroidism
• People monitored to assess FDA-approved osteoporosis drug therapy response

Frequency

• Every two years
• More frequently if medically necessary

See FAQ on how to check eligibility.

Patient Pays — No copayment, coinsurance, or deductible

Other Notes

• Don't report CPT® codes 77080 with 77085 or 77086. We don’t cover CPT® code 77086 for this service.
• When coding CPT® codes 77085 and 77081 together, attach HCPCS modifier XU (unusual non-overlapping service, a distinct service because it doesn’t overlap usual components of the main service) to CPT® code 77081 to bypass Correct Coding Initiative edit
• When coding CPT© codes 77080 and 77081 together, attach HCPCS modifier XU (unusual non-overlapping service, a distinct service because it doesn’t overlap usual components of the main service) to CPT® code 77080

CPT® only copyright 2023 American Medical Association. All rights reserved.

Resources

• MLN006559 — Medicare Preventive Services
• National Osteoporosis Foundation Millman 2021 Repor