dexa scan cpt code

(2022) DEXA Scan CPT Codes Bone Density – Description, Guidelines, Reimbursement & Modifiers

DEXA Scan CPT Code(s) are 77080, 77081, 77085, and 77086 and can be reported for services when the physician performs Dual-energy X-ray absorptiometry (DEXA or DXA) to evaluate bone mineral density (BMD) such as calcium and amount of the other minerals of axial and appendicular skeleton or Vertebral fracture assessment.

DEXA Scan CPT Code Description

DEXA can be performed for screening, treatment review, and diagnostic purposes. It can be performed due to numerous factors such as the family history of osteoporosis, increased age can also reduce bone density, prior fractures or injuries lead to loosening bone density, and some medication also contributes to lower the level of bone density.

Sometimes, a patient with multiple chronic bone illnesses, including lupus, diabetes, rheumatoid arthritis, and other organ diseases, can also influence the bones to break down.

It can be measured for wrists, heels, hips, spine, and radius. The DEXA utilized two beams of X-ray.

One is high energy, and the other is low and monitored alternatively. The results are interpreted in standard deviation formats. It usually shows people from 30 years of age, representing the bone mass’s age peak.

If a DEXA study is performed on the hips, pelvic and spines region, then it will be reported with CPT code 77080, while it is done along with vertebral fracture assessment, then it will be reported with CPT code 77085.

If it is done on wrists or heel bones, it will be appropriate to bill with CPT code 77081.

CPT code 77086 will be reported when the physician performs only a vertebral fracture assessment.

cpt code for bone density dexa scan
DXA Scan CPT Code Descriptions 76977, 78350 and 78351.

DEXA scan CPT code 77080 is used for billing services when Dual-energy X-ray absorptiometry is performed by the physician to study the bone density of the axial skeleton (e.g., hips, pelvis, spine) on one or more sites.

TIP: You can find the billing guide for CPT code 77080 here.

DEXA scan CPT code 77081 is used for billing services when Dual-energy X-ray absorptiometry is performed by the physician to study the bone density of the appendicular skeleton (peripheral) (e.g., radius, wrist, heel) on one or more sites.

DEXA scan CPT code 77085 is used for billing services when Dual-energy X-ray absorptiometry is performed by the physician to study the bone density of the axial skeleton (e.g., hips, pelvis, spine) on one or more sites in conjunction with vertebral fracture assessment.

DEXA scan CPT code 77086 is used for billing services when Dual-energy X-ray absorptiometry is performed by the physician for assessment of Vertebral fracture only.

cpt code dexa scan
DXA Scan CPT Code Descriptions 77080, 77081, 77085 and 77086.

DEXA Scan CPT Code Reimbursement

A maximum of 1 unit of CPT codes 77080 – 77086 can be billed on the same date of service, while 2 units can be billed if documentation supports the medical necessity. The cost and RUVs of CPT 77080 –77086 are as follows:

CPT 77080 – 77086 with Modifier 26:
Facility Price: Cost $10.36 RUVS 0.29942
Non-Facility Price: Cost $10.36 RUVS 0.29942

CPT 77080 – 77086 with Modifier TC (Technical Component):
Facility Price: Cost $33.20 RUVS 0.95932
Non-Facility Price: Cost $33.20 RUVS 0.95932

CPT 77080 – 77086 Global price (Without 26 and TC):
Facility Price: Cost 1.25874 RUVS 4.66701
Non-Facility Price: Cost $43.56 RUVS 1.25874

DEXA Scan CPT Code Modifiers

The following list is of modifiers that are applicable with CPT Codes 77080 – 77086:

  • 22, 23, 26, 51, 52, 53, 59, 76, 77, 78, 79, 99, AQ, AI, AR, CC, CR, ET, EY, FX, FY, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, QQ, SG, TC, XE, XS, XP, and XU.

The most frequently used modifiers 26, TC, 77, 76, 59 or X {E, P, S, U} with CPT CODES 77080 – 77086.

Modifier 26 is used to indicate the professional services or equipment and applicable with CPT codes 77080 – 77086 when the physician performs service in a hospital or does not own the equipment used in DEXA studies or employee in the Facility.

While modifier TC is used to indicate technical components such as machinery used in the MRI Cervical spine (72141).

It would be reported by Hospital or third party who owned the equipment. CPT codes 77080 – 77086 will be globally billed when service is performed in a private office or the physician owns the equipment. Globally billed means without modifier 26 or TC.

If service is performed twice by the same physician on the same date of service, then CPT codes 77080 – 77086 would be reported with Modifier 76, while service performed by a different physician on the same day is appropriate to attach modifier 77 with CPT Codes 77080 – 77086.

Modifier 59 is applicable with CPT codes 77080 – 77086 when service is not normally performed together on the same service date but bundled with other procedures. For further specifications, Medicare accepts modifiers XU, XE, XP, and XS instead of placement of modifier 59 with CPT codes 77080 – 77086.

Modifier Q6 is applicable with CPT codes 77080 – 77086 for locum tenants billing or temporary substitute physicians. For example, suppose the radiologist is on leave or in the absence of an original physician.

In that case, services are provided by the temporary physician or substitute physician with modifier Q6 under the name of the original provider, not with Loum tenant.

Modifier 53 applies to CPT codes 77080 – 77086 when the physician terminates the procedure due to unavoidable circumstances and plans to repeat the procedure in the future, while modifier 52 willbe attached to the CPT codes 77080 – 77086 if the procedure is performed incomplete by the physician and do not have a plan to repeat the procedure.

cpt code for a dexa scan
DXA Scan Modifiers

DEXA Scan CPT Code Billing Guidelines

Documentation should support the medical necessity of service and be medically appropriate. The appropriate ICD 10 codes should be reported to the claims for reimbursement. The most billed dx codes are Z13.820, M81.0, M85.89, etc.

These CPT codes 77080, 77081, 77085, and 77086 have technical and professional components. Therefore, it should be billed with an appropriate 26 or TC modifier. If the physician owns the practice, these modifiers TC and 26 are not required.

If DEXA scan CPT code 77080 is billed along with CPT code 77081, it is allowed to be billed together on the same service date with the appropriate modifier.

If DEXA CPT code 77080 is billed along with CPT code 77085, it is not allowed to bill together on the same day.

This is because only CPT code 77085 will be reported due to higher payment, while CPT code 77081 is allowed to bill in conjunction with CPT code 77085 with the appropriate modifier.

If the DEXA CPT 77086 code is billed with CPT 77080, it is not allowed to bill together on the same service date. Only CPT 77080 will be reported due to higher payments.

If the DEXA scan CPT code 77086 code is billed with CPT 77085, it is not allowed to bill together on the same service date. Only CPT 77085 will be reported due to higher payments.

Examples

Below is a list of examples of when DEXA scan CPT code may be used.

Example 1

A 56-year-old female with post-menopausal status presented with pain in both upper and
lower extremities. Pain is constant and gets better for 3 to 4 hours after taking pain medication.

She denies trauma, heavy lifting, palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope, or syncope, changes in stool color, urinary complaints, or any other symptoms.

The physician ordered a DEXA scan of both upper and lower extremities. Exam revealed that patients have age-related osteoporosis. The physician prescribed medication for pain and treatment of osteoporosis.

Example 2

A 72-year-old male with low back pain and radiculopathy of the lumbar region. The patient has intermittent pain and lasts for two hours.

He denies trauma, heavy lifting, palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope, or syncope, changes in stool color, urinary complaints, or any other symptoms.

The physician ordered a DEXA scan of the spine. Exam revealed that patients have
osteopenia and degeneration of the spine. Physicians prescribed medication for osteopenia.

Example 3

A 45-year-old male presented to the office for a screening exam of osteoporosis with a strong family history of his aunt and uncle. The patient is currently asymptomatic and has no other symptoms.

The patient is here for confirmation if there is any risk for osteoporosis soon. The physician ordered a DEXA scan to screen for osteoporosis. The result revealed that the patient has a normal bone density with no abnormal findings.

Example 4

A 56-year-old female with a past medical history of traumatic injury to the right foot with tingling and numbness. The patient is unable to walk normally and feels drops in the foot.

She denies palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope or syncope, urinary complaints, or other symptoms. The physician ordered a DEXA scan of the right lower limb. The exam revealed that the patient has osteopenia of the right lower limb.

Example 5

A 35-year-old-male patient presented to the office who is taking steroid medication for bodybuilding. He felt numbness and tingling in both hands for two weeks while weightlifting.

The condition worsens day by day, and now he has body aches. The patient has no family history of osteoporosis but is taking steroid medication. The physician ordered a DEXA scan of both hands and revealed an abnormal study of bone density.

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