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Please help with Medicare fee schedule-bone density tests

Margaret Posted Tue 18th of January, 2011 19:45:28 PM

Good afternoon!

My manager asked me to locate what Medicare will pay for a bone densimeter. They are looking into purchasing a machine. I found a couple of CPT codes, but not sure which one I am supposed to use and was hoping someone could help.

Codes I could find on Highmark Medicare site were:

G0130
77083
77081

Which ones would I use to code, HCPCS alone or with another CPT code.

Thanks in advance for your help!

SuperCoder Answered Wed 19th of January, 2011 09:01:57 AM

Certain BMM tests are covered when used to screen patients for osteoporosis subject to the
frequency standards described in chapter 15, section 80.5.5 of the Medicare Benefit Policy
Manual.
Medicare Services will pay claims for screening tests when coded as follows:
· Contains CPT procedure code 77078, 77079, 77080, 77081, 77083, 76977 or G0130,
and
· Contains a valid ICD-9-CM diagnosis code indicating the reason for the test is
postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.
Medicare Services will deny claims for screening tests when coded as follows:
· Contains CPT procedure code 77078, 77079, 77081, 77083, 76977 or G0130, but
· Does not contain a valid ICD-9-CM diagnosis code from the local lists of valid ICD-9-CM
diagnosis codes maintained by the contractor for the benefit’s screening categories
indicating the reason for the test is postmenopausal female, vertebral fracture,
hyperparathyroidism, or steroid therapy.
Dual-energy x-ray absorptiometry (axial) tests are covered when used to monitor FDA-approved
osteoporosis drug therapy subject to the 2-year frequency standards described in chapter 15,
section 80.5.5 of the Medicare Benefit Policy Manual.
Medicare Services will pay claims for monitoring tests when coded as follows:
· Contains CPT procedure code 77080, and
· Contains 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 as the ICD-9-CM
diagnosis code.
Medicare Services will deny claims for monitoring tests when coded as follows:
· Contains CPT procedure code 77078, 77079, 77081, 77083, 76977 or G0130, and
· Contains 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 as the ICD-9-CM
diagnosis code, but
· Does not contain a valid ICD-9-CM diagnosis code from the local lists of valid ICD-9-CM
diagnosis codes maintained by the contractor for the benefit’s screening categories
indicating the reason for the test is postmenopausal female, vertebral fracture,
hyperparathyroidism, or steroid therapy.Revised 9/24/10 Coverage Issues – Page 4
Medicare will not pay BMM claims for single photon absorptiometry. Medicare Services will
deny CPT procedure code 78350.

Margaret Posted Wed 19th of January, 2011 12:49:26 PM

Thanks for your answer to my question. It is very much appreciated!

Marianne Answered Wed 19th of January, 2011 13:44:06 PM

Q9967 Low Osmolar Contrast Injection. ??? Must we state the amount and type of contrast in the report in order to get paid by insurance?

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