The information below covers specifics relating to billing and payment for DEXA scans utilized to assess the risk of atypical femoral fracture.
Medicare Part B covers DEXA scans (bone mass measurement) once every 24 months for people who are at risk for osteoporosis and meet one or more of the following conditions:
- A woman whose doctor determines, based on her medical history and other findings, that she is estrogen deficient and at risk for osteoporosis.
- A patient whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
- A patient taking prednisone or steroid-type drugs, or who is planning to begin this treatment.
- A patient diagnosed with primary hyperparathyroidism.
- A patient being monitored to see if their osteoporosis drug therapy is working.
The test may be covered more often than once every 24 months if it’s medically necessary.
Under Original Medicare, patients pay nothing for this test if their physician or another qualified healthcare provider requests it.
Current Procedural Terminology (CPT) 4 Coding and Definitions
|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)|
|76977||Other Diagnostic Ultrasound Procedures; bone density measurement and interpretation, peripheral site(s), any method|
ICD-10 Codes and DEXA scans
Many ICD-10 codes cover fractures, but there are other ICD-10 codes Medicare will cover when used with a DXA Bone Scan (77080):
- 0 // Asymptomatic menopausal state
- 3 // Long term (current) use of hormonal contraceptives
- 51 // Long term (current) use of inhaled steroids
- 52 // Long term (current) use of systemic steroids
- 83 // Long term (current) use of bisphosphonates
- 310 // Personal history of (healed) osteoporosis fracture
The screening code and the risk factor code must be provided. Claims for “Screening DXA Bone Density” without any other indication will be denied by Medicare.
Disclosure: This information is provided for users’ convenience without guarantee of any sort offered or implied.