CPT code 76977, 77078, 77080, 77081 and G0130 – covred ICD 10 and benefit period by Medical Billing 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 (eg, hips, pelvis, spine)
Full Answer
What is Procedure Code 77080?
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1861 (rr) (1) and (s) (15) refers bone mass measurements
- Title XVIII of the Social Security Act, Section 1862 (a) (1) (A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary ...
- Title XVIII of the Social Security Act, Section 1862 (a) (7). ...
What diagnosis will cover 77080 for Medicare?
• BMM is covered when dual-energy x-ray absorptiometry is used to monitor osteoporosis drug therapy. Therefore, Medicare will pay procedure code 77080 when billed with the following ICD-9-CM diagnosis codes or any of the other valid ICD-9-CM diagnoses that are recognized by Medicare contractors appropriate for bone mass measurements:
Does Medicare cover 77080?
Dr. Robert Michael (Mike) Leath is a family medicine doctor in Houston, Texas. He received his medical degree from University of Texas Medical Branch School of Medicine and has been in practice ...
What is medical procedure code 77080?
Effective for dates of service on or after January 1, 2007, Medicare will pay for BMM services for dual-energy x-ray absorptiometry (CPT code 77080) when this procedure is used to monitor osteoporosis drug therapy.
What ICD 10 code covers screening DEXA scan for Medicare?
ICD-10 CM code Z79. 83 should be reported for DXA testing while taking medicines for osteoporosis/osteopenia. ICD-10 CM code Z09 should be reported for an individual who has COMPLETED drug therapy for osteoporosis and is being monitored for response to therapy.
What diagnosis will Medicare cover for a DEXA scan?
osteoporosisMedicare coverage Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures. You're taking prednisone or steroid-type drugs or are planning to begin this treatment. You've been diagnosed with primary hyperparathyroidism. You're being monitored to see if your osteoporosis drug therapy is working.
What diagnosis codes cover bone density?
77080CodeDescriptionM85.841Other specified disorders of bone density and structure, right handM85.842Other specified disorders of bone density and structure, left handM85.851Other specified disorders of bone density and structure, right thighM85.852Other specified disorders of bone density and structure, left thigh124 more rows
Does Medicare cover DEXA bone scan?
Does Medicare Cover DEXA Scans? In most cases, Medicare insurance does cover DEXA scans under Part B. Medicare Part B (Medical Insurance) provides benefits for outpatient procedures that are deemed medically necessary for ongoing treatment of illness.
Does Medicare cover 77080?
Effective for dates of service on or after January 1, 2007, Medicare will pay for BMM services for dual-energy x-ray absorptiometry (CPT code 77080) when this procedure is used to monitor osteoporosis drug therapy.
What ICD-10 code covers bone scan?
Encounter for screening for osteoporosis Z13. 820 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z13. 820 became effective on October 1, 2021.
Is bone density covered by Medicare?
Bone mass measurements (also called bone density tests) can help determine if you need medical treatment for osteoporosis, a condition that can cause brittle bones in older adults. Medicare Part B covers bone mass measurement every two years if you are at risk for osteoporosis and have a referral from your provider.
What is the ICD-10 code for bone density?
ICD-10 Code for Disorder of bone density and structure, unspecified- M85. 9- Codify by AAPC.
What is the difference between 77080 and 77085?
CPT Code 77085 is a combination code that includes axial dual-energy X-ray absorptiometry (DXA) as well as VFA, while CPT 77086 represents a stand-alone VFA. The existing codes for axial and appendicular DXA studies (CPT 77080, CPT 77081) are not changing and will be used whenever DXA is performed without VFA.
What is the ICD 10 code for screening for osteoporosis?
Z13. 820 Encounter for screening for osteoporosis - ICD-10-CM Diagnosis Codes.
What is the CPT code 77080?
Bone Density Scan CPT COde CPT 77080 is used to code for bone density scan of axial bone like hip, pelvis and spine while 77081 was used to code axial bone like wrist, radius, heel etc.
What is CPT code for DEXA scan?
Group 1CodeDescription77080DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)77085DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE), INCLUDING VERTEBRAL FRACTURE ASSESSMENT1 more row
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Bone Mineral Density Studies. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy.
Coverage Guidance
Bone (mineral) density studies are used to evaluate diseases of bone and/or the responses of bone diseases to treatment. The studies access bone mass or density associated with such diseases as osteoporosis, osteomalacia, and renal osteodystrophy.
When medical records are requested, are letters of support and/or explanation useful?
When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included. System coding changes.
Can Medicare pay for 77080?
The basic clarification is that Medicare allows codes other than CPT code 77080 (i.e., 76977, 77078, 77079, 77081, 77083, and G0130) to be paid even though claims for such services report both a screening diagnosis code and an osteoporosis code.
How often does Medicare cover dexa?
Medicare will cover DEXA bone mass measurement once every 2 years on a person who falls into 1 out of the 5 Following categories: 1. A woman who has been determined by her physician to be estrogen-deficient and at clinical risk for osteoporosis. 2.
Does BCBSNC cover BMD?
BCBSNC will provide coverage for Axial (Central) Bone Mineral Density (BMD) Studies when they are determined to be medically necessary because the medical criteria and guidelines shown below are met.
Can Medicare reimburse bone mass?
Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied (e.g., if the spine and hip are studied, Procedure code 77080 should be billed only once).
Does Priority Health cover BMD?
Priority Health will limit coverage for BMD studies to central DXA only. Any other BMD studies (e.g. peripheral, such as wrist, finger and heel) are not medically/clinically necessary and, therefore, not covered. BMD studies will not be prior authorized by Priority Health.
What is CPT code 77080?
CPT 77080 is used to code for bone density scan of axial bone like hip, pelvis and spine while 77081 was used to code axial bone like wrist, radius, heel etc. While coding 77085 and 77081 together do remember to use modifier XU with cpt code 77081.
How often does Medicare cover bone mass?
Medicare covers bone mass measurements every 2years for “qualified” individuals considered to be at risk for osteoporssiis. Medicare beneficiary who meets the medical indications for one of the following categories: 1. an estrogen-defiicient, postmenopausal woman. 2. an individual with verteebraal abnormalities.
What are the categories of Medicare beneficiaries?
Certain Medicare beneficiaries 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;