Bone Mass Measurement: Medicare Policy Revision

Tuesday, February 19, 2008 at 10:17:22 AM

Please note the following revisions with respect to Medicare's Bone Mass Measurement policy (A45896), effective 2/1/08:

For CPT code 77080 only (after the diagnosis of osteopenia or Cushing’s Syndrome has been established, for the purpose of following or monitoring the result of FDA-approved osteoporosis drugs. Such drugs include the bisphosphonates, calcitonin, and estrogen replacement drugs.) (255.0, 733.00-733.09, 733.90, V67.51)

CPT codes 77078, 77079, 77081, 77083, 76977 and G0130 reported with one of the following ICD-9-CM codes will be denied UNLESS the stated diagnosis reflects the results, when performed for screening, as documented by the inclusion on the claim of a second ICD-9 code describing the reason for the screening test. (255.0, 733.00 - 733.09, 733.90)

These following diagnoses may support medical necessity for CPT codes 77078, 77079, 77080. 77081, 77083, 76977 and G0130, when these tests are performed for bone mass density screening for potential osteopenia/osteoporosis in qualified beneficiaries with estrogen deficiency, vertebral abnormalities/fractures, primary hyperparathyroidism or glucocorticoid administration. (252.01, 256.2, 256.31, 256.39, 259.3, 627.0 - 627.9, 733.13, 756.51, 758.6, 793.7, 805.00 - 805.9, 806.00 - 806.09, 806.10 - 806.19, 806.20 - 806.29, 806.30 - 806.39, 806.4, 806.5, 806.60 - 806.69, 806.70 - 806.79, 806.8, 806.9, E932.0, V45.77, V49.81, V58.65)


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