(2023) DEXA Scan CPT Codes Bone Density – Description, Guidelines, Reimbursement & Modifiers

DEXA Scan CPT Code 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 Explanation

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 contributes to lower 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.

CPT Codes For DEXA Scan

There are four CPT codes for DEXA Scan ((Dual-Energy X-ray Absorptiometry Scan) and are as follows.

CPT Code 77080

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

Official description: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine).

CPT Code 77081

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

Official description: “Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel).”

CPT Code 77085

DEXA scan CPT code 77085 is used for billing services when the physician performs Dual-energy X-ray absorptiometry 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.

Official description: “Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment.”

CPT Code 77086

DEXA scan CPT code 77086 is used for billing services when the physician performs Dual-energy X-ray absorptiometry to assess vertebral fracture only.

Official description: “Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA).”

Reimbursement

A maximum of 1 unit of CPT codes 77080 – 77086 can be billed on the same service date, while two units can be billed if documentation supports the medical necessity.

The reimbursement for the DEXA scan CPT codes includes the cost and RUVs of CPT 77080 –77086 and 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

How To Use Modifiers With The CPT Codes For DEXA Scan

Modifier 26 is used to indicate the professional services or equipment. It applies to the CPT codes for DEXA Scan when the physician performs service in a hospital, does not own the equipment used in DEXA studies, or is an employee in the Facility.

While modifier TC indicates technical components such as machinery used in the MRI Cervical spine (CPT 72141).

It would be reported by the hospital or a 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 applies with CPT codes 77080 – 77086 when service is not customarily performed on the same service date but bundled with other procedures. For further specifications, Medicare accepts modifiers XU, XE, XP, and XS instead of the 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 the 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. In contrast, modifier 52 will be attached to CPT codes for DEXA Scan if the procedure is performed incompletely by the physician and do not have a plan to repeat the procedure.

Billing Guidelines

The DEXA scan CPT codes 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 the DEXA Scan CPT code 77080 is billed along with CPT code 77081, it can 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 cannot 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 cannot 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 cannot bill together on the same service date. Only CPT 77085 will be reported due to higher payments.

Examples

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

Example 1

A 56-year-old female with post-menopausal status presented 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 the upper and lower extremities. Exam revealed that patients had age-related osteoporosis. The physician prescribed medication for pain and treatment of osteoporosis.

Billing:

CPT Codes:

• CPT 99213: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s visit to discuss her extremity pain and undergo examination.
• CPT 77080: Dual-energy X-ray absorptiometry (DEXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine): This code is used to document the DEXA scan ordered to assess the patient’s bone density in both the upper and lower extremities.

ICD-10 Codes:

• ICD 10 M81.0: Age-related osteoporosis without current pathological fracture: This code documents the patient’s diagnosis of age-related osteoporosis.
• ICD 10 M79.604: Pain in right leg and ICD 10 M79.605: Pain in left leg: These codes are used to document the patient’s pain in the lower extremities.
• ICD 10 M79.621: Pain in right upper arm and ICD 10 M79.622: Pain in left upper arm: These codes are used to document the patient’s pain in the upper extremities.

Example 2

A 72-year-old male with low back pain and radiculopathy of the lumbar region. The patient has intermittent pain, which 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.

Billing:

CPT Codes:

• CPT 99213: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s visit to discuss their low back pain and radiculopathy of the lumbar region.
• CPT 77080: Dual-energy X-ray absorptiometry (DEXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine): This code is used to document the DEXA scan of the spine ordered by the physician.

ICD-10 Codes:

• ICD 10 M54.16: Radiculopathy, lumbar region: This code is used to document the patient’s radiculopathy of the lumbar region.
• ICD 10 M54.5: Low back pain: This code documents the patient’s low back pain.
• ICD 10 M41.9: Scoliosis, unspecified: This code documents the patient’s spine degeneration.
• ICD 10 M85.80: Other specified disorders of bone density and structure, unspecified site: This code documents the patient’s osteopenia diagnosis.

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 normal bone density with no abnormal findings.

Billing:

CPT Codes:

• CPT 99213: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s visit to discuss their family history of osteoporosis and the need for a screening exam.
• CPT 77080: Dual-energy X-ray absorptiometry (DEXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine): This code is used to document the DEXA scan ordered by the physician to screen for osteoporosis.

ICD-10 Codes:

• ICD 10 Z82.62: Family history of osteoporosis: This code documents the patient’s strong family history of osteoporosis (aunt and uncle).
• ICD 10 Z13.820: Encounter for screening for osteoporosis: This code is used to document the patient’s screening exam for osteoporosis due to their family history.

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, 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.

Billing:

CPT Codes:

• CPT 99213: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s visit to discuss their traumatic injury to the right foot and associated symptoms.
• CPT 77081: Dual-energy X-ray absorptiometry (DEXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel): This code is used to document the DEXA scan of the right lower limb ordered by the physician.

ICD-10 Codes:

• ICD 10 S93.401A: Unspecified sprain of the right foot, initial encounter: This code is used to document the patient’s past traumatic injury to the right foot.
• ICD 10 R20.2: Paresthesia of skin: This code is used to document the patient’s tingling and numbness in the right foot.
• ICD 10 M21.371: Foot drop, right foot: This code is used to document the patient’s inability to walk normally and foot drop in the right foot.
• ICD 10 M85.671: Other specified disorders of bone density and structure, right ankle, and foot: This code is used to document the patient’s osteopenia of the right lower limb.

Example 5

A 35-year-old male patient taking steroid medication for bodybuilding presented to the office. 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, revealing an abnormal bone density study.

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial office visit where the patient presented with numbness, tingling, and body aches while taking steroid medication.
• CPT 77082: Dual-energy X-ray absorptiometry (DEXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel): This code is used to document the DEXA scan ordered by the physician to evaluate the patient’s bone density in both hands.

ICD-10 Codes:

• ICD 10 G64: Disorders of peripheral nerves: This code documents the patient’s numbness and tingling in both hands.
• ICD 10 M79.1: Myalgia: This code documents the patient’s body aches.
• ICD 10 E55.9: Unspecified Vitamin D deficiency: This code documents the patient’s abnormal bone density study results.
• ICD 10 Z79.52: Long term (current) use of systemic steroids: This code documents the patient’s use of steroid medication for bodybuilding.