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Preventive Services: Bone Mass Measurements

By:  Find-A-Code
Published:  September 1st, 2017

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Bone Mass Measurements: 

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 (e.g., hips, pelvis, spine)
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)
G0130 - Single energy X-ray absorptiometry (SEXA) bone density study, 1 or more sites, appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

ICD-10 Codes

M81.0, M81.6, M81.8, M85.811, M85.812, M85.821, M85.822, M85.831, M85.832, M85.841, M85.842, M85.851, M85.852, M85.861, M85.862, M85.871, M85.872, M85.88, M85.89, M94.9

Who Is Covered

Certain Medicare beneficiaries who fall into at least one of the following categories:

  • Women determined by their physician or qualified nonphysician 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

Frequency

  • Every 2 years
  • More frequently if medically necessary

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.


References:

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