Proper Reporting for Bone Mass Measurement
- Is ordered by the physician or qualified nonphysician practitioner who is treating the beneficiary following an evaluation of the need for a BMM and determination of the appropriate BMM to be used.
- Is performed under the appropriate level of physician supervision as defined in 42 CFR 410.32(b).
- Is reasonable and necessary for diagnosing and treating the condition of a beneficiary who meets the conditions described in §80.5.6.
- In the case of an individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy, is performed with a dual-energy X-ray absorptiometry system (axial skeleton).
Coding for BMM
BMM claims for dual-energy X-ray absorptiometry (CPT® 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) are reimbursable when this procedure is used to monitor osteoporosis drug therapy.
New Guidelines for 2016
Medicare Benefit Policy Manual: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
Medicare Coverage Database, NCD 150.3: www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=256&ncdver=2&DocID=150.3&SearchType=Advanced&bc=IAAAABAAAAAA&
MLN Matters Article SE1525: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1525.pdf