Updated DXA Policy for Medicare Patients

March 6, 2017

Medicare covers DXA Bone Densitometry for certain Medicare beneficiaries who fall into at least one of the following categories:

1.) A woman whose doctor has determined she’s estrogen-deficient and at a clinical risk for osteoporosis, based on her medical history and other findings.

2.) Patient with vertebral abnormalities as demonstrated by x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.

3.) Patient receiving or expecting to receive glucocorticoid (steroid) therapy equivalent to an average of 5.0mg of prednisone, or greater per day for more than 3 months.

4.) Patient with primary hyperparathyroidism.

5.) Patient being monitored to assess their response to or efficacy of an FDA-approved osteoporosis drug therapy.

Medicare beneficiaries who meet the above criteria may have a Diagnostic DXA once every 24 months (more often if medically necessary).

In addition to the many ICD-10 codes for fracture, the following diagnosis codes, when used with a DXA Bone Scan (77080) will be accepted and paid by Medicare:

Z78.0 Asymptomatic menopausal state
Z79.3 Long term (current) use of hormonal contraceptives
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.83 Long term (current) use of bisphosphonates
Z87.310 Personal history of (healed) osteoporosis fracture

Please note – Medicare will deny any claim that says “Screening DXA Bone Density” without any other indication and your patient will have to sign an ABN and pay out of pocket.  

If you have any questions, please do not hesitate to contact us at 609.921.8211.