Bone Mass Measurements - JE Part B

HCPCS/CPT Codes

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

Frequency

Every two years; more frequently if medically necessary

Coverage

Beneficiary must fall into one of the following categories:

• Women determined by physician or qualified non-physician practitioner 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 three months
• Individuals with primary hyperparathyroidism
• Individuals being monitored to assess response to U.S. Food and Drug Administration (FDA)-approved osteoporosis drug therapy

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

No

Resources

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.5
• CMS Medicare Preventive Services