- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Bone Mass Measurements
Table of Contents
Bone Mass Measurements
An estimated ten million Americans have osteoporosis and over 34 million Americans have low bone mass, placing them at risk for osteoporosis. Osteoporosis is a preventable, treatable disease, early diagnosis and treatment can reduce and/or prevent bone fractures.
Risk Factors
- Age 50 or older
- Female gender
- Family/personal history of broken bones
- Caucasian or Asian ethnicity
- Small bone structure
- Low body weight (less than 127 pounds)
- Frequent smoking or drinking
- Low-calcium diet
Coverage Guidelines and Frequency Limits
- Covered once every two years when performed on “qualified” individual or more frequently if medically necessary
- “Qualified” individual meets medical indications for at least one of the following coverage categories
- Estrogen-deficient woman at clinical risk for osteoporosis, based on medical history and other findings
- Individual with vertebral abnormalities, as demonstrated by X-ray to be indicative of osteoporosis, osteopenia or vertebral fracture
- Individual with known primary hyperparathyroidism
- Individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to an average of 5.0 mg of prednisone or greater per day for more than three months
- Individual being monitored to assess response to FDA-approved osteoporosis drug therapy
Coverage Criteria
- Radiologic or radioisotopic procedure
- Must be performed:
- With bone densitometer (other than DPA or bone sonometer device approved by FDA)
- For purpose of identifying bone mass, detecting bone loss or determining bone quality
- Includes physician’s interpretation of results
- Physician or NPP must provide an order
- Following evaluation of need for measurement
- Includes determination of the medically appropriate measurement to be used
- Must be furnished by a qualified provider/supplier, under appropriate supervision by physician
- Services must be medically necessary
- More frequent screenings may be covered when medically necessary to include but not limited to:
- Monitoring beneficiaries on long-term glucocorticoid (steroid) therapy of more than three months
- Confirming baseline BMMs to permit monitoring of beneficiaries in the future
- Follow up bone mineral density testing to assess FDA-approved osteoporosis drug therapy until a response to such therapy has been documented over time
HCPCS/CPT Coding
- *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)
- 77085 ‒ Dual-energy X-ray absorptiometry (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, 1 or more sites, appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
* Indicates that this can be billed as a prolonged preventive service add-on. These codes are identified by a clock symbol beside the HCPCS/CPT code.
HCPCS/CPT Codes
- G0513 ‒ Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for the preventive service)
- G0514 ‒ Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service
ICD-10 Codes
- E21.0, E21.3, E23.0, E34.2, E89.40, E89.41, M80.08xA, M80.88xA, M84.58xA, M84.68xA, N95.8, N95.9, Q78.0, S34.3xxA, Z78.0, Z79.3, Z79.51, Z79.52, Z79.61, Z79.64, Z79.85, Z79.620, Z79.621, Z79.622, Z79.623, Z79.624, Z79.630, Z79.631, Z79.632, Z79.633, Z79.634, Z79.811, Z79.818, Z79.83, Z87.310
Note: Additionally, you may use the specific ICD-10 codes listed above 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, or S34.1.
Note: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual Change Requests (CRs) and the specific ICD-10-CM codes Medicare covers for this service
Diagnosis Coding
- Use the appropriate diagnosis code
- For individual change requests and coding translations for ICD-10
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Billing Tips
- Do not report 77080 with 77085 or 77086. Do not report 77085 with 77080 or 77086. Do not report 77086 with 77080 or 77085. Medicare does not cover 77086 for this service.
- When coding 77085 and 77081 together, attach modifier –XU (Unusual nonoverlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 77081 to bypass Correct Coding Initiative edit.
- When coding 77080 and 77081 together, attach modifier –XU (Unusual nonoverlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 77080.
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 13, Section 140
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.5
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/12/2023