CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130:
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1 Bone Mass Measurements Coverage Information Noridian Administrative Services (NAS), LLC, is providing coverage information regarding Bone Mass Measurements (BMM) in response to multiple provider inquiries. This article contains instructions for coding medical necessity in accordance with both the national coverage determinations (NCD) and Centers for Medicare and Medicaid Services (CMS) instructions on BMM. These coding guidelines are not intended to replace any found in the ICD-9-CM Official Guidelines for Coding and Reporting, nor are they intended to provide guidance on when a condition should be coded. Rather, providers should use this article in conjunction with the UB-04 Data Specifications Manual and the ICD-9-CM Official Guidelines for Coding and Reporting. Bone Mass Measurement screening may, for specific beneficiaries; be completed once every 2 years (at least 23 months have passed since the month the last covered BMM was performed). In order for the screening to be covered, the beneficiary must meet at least one of the following conditions as listed in the Medicare Benefit Policy Manual (MBPM) Chapter 15, section CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130: A woman who has been determined by the physician or qualified Non-Physician Practitioner (NPP) treating her to be estrogen-deficient and at clinical risk for osteoporosis based on her medical history and other findings. An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture. An 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 3 months. An individual with primary hyperparathyroidism. CPT only: An individual being monitored to assess the response to or efficacy of an FDAapproved osteoporosis drug therapy. Confirming baseline BMM or BMMs to permit monitoring beneficiaries in the future. When medically necessary, coverage of more frequent BMMs may be indicated. Examples include, but are not limited to the following medical circumstances: Monitoring beneficiaries on long-term glucocorticoid (steroid) therapy of more than 3 months; (CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130) In order for the BMM to be covered, the testing must be completed under the following conditions found in MBPM Chapter 15 section :
2 The physician or qualified nonphysician practitioner (NPP) who is treating the beneficiary must order the BMM as well as determine the appropriate BMM to be used. The BMM must be performed under the appropriate level of physician supervision as defined in 42 CFR (b). The BMM is reasonable and necessary for the diagnosing and treating the condition of a beneficiary who meets the conditions described above. In the case of BMM for the monitoring of the effectiveness of drug therapy for osteoporosis, coverage is limited to Dual-energy X-ray Absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine); CPT In the case of a confirmatory baseline BMM, coverage is limited to a BMM completed by DEXA system (axial skeleton) for an individual and above conditions are met as well as the initial BMM was not performed using a DEXA system (axial skeleton). Diagnosis codes that support coverage of CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130 include: (NOTE: Providers may code screening, V82.81, or other codes as appropriate. However, only the following codes will support medical necessity for this NCD.) HYPERPARATHYROIDISM, UNSPECIFIED PRIMARY HYPERPARATHYROIDISM SECONDARY HYPERPARATHYROIDISM, NON-RENAL OTHER HYPERPARATHYROIDISM PANHYPOPITUITARISM IATROGENIC PITUITARY DISORDERS CUSHING'S OTHER CORTICOADRENAL OVERACTIVITY POSTABLATIVE OVARIAN FAILURE PREMATURE MENOPAUSE OTHER OVARIAN FAILURE POLYCYSTIC OVARIES OTHER OVARIAN DYSFUNCTION UNSPECIFIED OVARIAN DYSFUNCTION ECTOPIC HORMONE SECRETION NOT ELSEWHERE CLASSIFIED RENAL OSTEODYSTROPHY SECONDARY HYPERPARATHYROIDISM (OF RENAL ORIGIN)
3 OTHER SPECIFIED DISORDERS RESULTING FROM IMPAIRED RENAL FUNCTION ABSENCE OF MENSTRUATION PREMENOPAUSAL MENORRHAGIA POSTMENOPAUSAL BLEEDING SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES POSTMENOPAUSAL ATROPHIC VAGINITIS SYMPTOMATIC STATES ASSOCIATED WITH ARTIFICIAL MENOPAUSE OTHER SPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDERS UNSPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDER ANKYLOSING SPONDYLITIS OSTEOPOROSIS UNSPECIFIED SENILE OSTEOPOROSIS IDIOPATHIC OSTEOPOROSIS DISUSE OSTEOPOROSIS OTHER OSTEOPOROSIS PATHOLOGICAL FRACTURE OF VERTEBRAE DISORDER OF BONE AND CARTILAGE UNSPECIFIED KYPHOSIS (ACQUIRED) (POSTURAL) KYPHOSIS DUE TO RADIATION KYPHOSIS POSTLAMINECTOMY OTHER KYPHOSIS ACQUIRED LORDOSIS (ACQUIRED) (POSTURAL) LORDOSIS POSTLAMINECTOMY OTHER POSTSURGICAL LORDOSIS OTHER LORDOSIS ACQUIRED SCOLIOSIS (AND KYPHOSCOLIOSIS) IDIOPATHIC GONADAL DYSGENESIS CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL CLOSED FRACTURE OF FIRST CERVICAL VERTEBRA
4 CLOSED FRACTURE OF SECOND CERVICAL VERTEBRA CLOSED FRACTURE OF THIRD CERVICAL VERTEBRA CLOSED FRACTURE OF FOURTH CERVICAL VERTEBRA CLOSED FRACTURE OF FIFTH CERVICAL VERTEBRA CLOSED FRACTURE OF SIXTH CERVICAL VERTEBRA CLOSED FRACTURE OF SEVENTH CERVICAL VERTEBRA CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE OPEN FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL OPEN FRACTURE OF FIRST CERVICAL VERTEBRA OPEN FRACTURE OF SECOND CERVICAL VERTEBRA OPEN FRACTURE OF THIRD CERVICAL VERTEBRA OPEN FRACTURE OF FOURTH CERVICAL VERTEBRA OPEN FRACTURE OF FIFTH CERVICAL VERTEBRA OPEN FRACTURE OF SIXTH CERVICAL VERTEBRA OPEN FRACTURE OF SEVENTH CERVICAL VERTEBRA OPEN FRACTURE OF MULTIPLE CERVICAL VERTEBRAE CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT OPEN FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT CLOSED FRACTURE OF LUMBAR VERTEBRA WITHOUT SPINAL OPEN FRACTURE OF LUMBAR VERTEBRA WITHOUT SPINAL CLOSED FRACTURE OF SACRUM AND COCCYX WITHOUT OPEN FRACTURE OF SACRUM AND COCCYX WITHOUT SPINAL CLOSED FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT OPEN FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED CLOSED FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION
5 CLOSED FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD CLOSED FRACTURE OF C1-C4 LEVEL WITH CENTRAL CORD CLOSED FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED CLOSED FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED CLOSED FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION CLOSED FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD CLOSED FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED OPEN FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL OPEN FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD OPEN FRACTURE OF C1-C4 LEVEL WITH CENTRAL CORD OPEN FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED OPEN FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED SPINAL OPEN FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD OPEN FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD OPEN FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED CLOSED FRACTURE OF T1-T6 LEVEL WITH COMPLETE LESION
6 CLOSED FRACTURE OF T1-T6 LEVEL WITH ANTERIOR CORD CLOSED FRACTURE OF T1-T6 LEVEL WITH CENTRAL CORD CLOSED FRACTURE OF T1-T6 LEVEL WITH OTHER SPECIFIED CLOSED FRACTURE OF T7-T12 LEVEL WITH UNSPECIFIED CLOSED FRACTURE OF T7-T12 LEVEL WITH COMPLETE LESION CLOSED FRACTURE OF T7-T12 LEVEL WITH ANTERIOR CORD CLOSED FRACTURE OF T7-T12 LEVEL WITH CENTRAL CORD CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL OPEN FRACTURE OF T1-T6 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF T1-T6 LEVEL WITH ANTERIOR CORD OPEN FRACTURE OF T1-T6 LEVEL WITH CENTRAL CORD OPEN FRACTURE OF T1-T6 LEVEL WITH OTHER SPECIFIED OPEN FRACTURE OF T7-T12 LEVEL WITH UNSPECIFIED SPINAL OPEN FRACTURE OF T7-T12 LEVEL WITH COMPLETE LESION OPEN FRACTURE OF T7-T12 LEVEL WITH ANTERIOR CORD OPEN FRACTURE OF T7-T12 LEVEL WITH CENTRAL CORD OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED CLOSED FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY OPEN FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY
7 CLOSED FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED CLOSED FRACTURE OF SACRUM AND COCCYX WITH COMPLETE CAUDA EQUINA LESION CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER OPEN FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED OPEN FRACTURE OF SACRUM AND COCCYX WITH COMPLETE CAUDA EQUINA LESION OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER CLOSED FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL OPEN FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL V07.4 HORMONE REPLACEMENT THERAPY (POSTMENOPAUSAL) V49.81 ASYMPTOMATIC POSTMENOPAUSAL STATUS (AGE-RELATED) (NATURAL) V58.65 LONG-TERM (CURRENT) USE OF STEROIDS The following V codes support coverage for only CPT 77080, and no other procedure including 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130 when combined with one of the following diagnoses: , , , , , , V58.69* V67.51* V67.59* LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE CLASSIFIED OTHER FOLLOW-UP EXAMINATION * V67.51 to be used only for reporting an individual who has completed drug therapy for osteoporosis and is being monitored for response to therapy. * V67.59 and V58.69 to be used only for reporting an individual who is receiving
8 ongoing drug therapy for osteoporosis and is being monitored for effectiveness. References: Medicare Claims Processing Manual Chapter 13, section 140, Medicare Benefit Policy Manual Chapter 15 section 80.5, Change Request 5521, CR 5847, National Coverage Determination 150.3, 42 CFR ,CPT manual, HCPCS manual and ICD-9-CM Manual Effective Date: January 1, 2007
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