CPT code 77080 is for a DXA scan, which measures bone density in the spine or hip to assess osteoporosis or fracture risk.
CPT code 77080 is used for a DXA (Dual-energy X-ray Absorptiometry) bone density test that focuses on the axial skeleton, which includes the spine and hips. This test is commonly performed to assess bone health, particularly to diagnose conditions like osteoporosis or to evaluate the risk of fractures. By measuring the bone mineral density in these critical areas, healthcare providers can make informed decisions about a patient's bone health and necessary treatments.
When dealing with CPT codes 77079 and 77080, it is important to consider the potential need for modifiers to ensure accurate billing and reimbursement. Here is a list of modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when the service provided is the interpretation of the test results, separate from the technical component. If the provider is only performing the professional component, this modifier should be appended.
2. Modifier TC (Technical Component): This modifier is used when the service provided is only the technical aspect of the procedure, such as the operation of the equipment and the provision of the facility. If the provider is only responsible for the technical component, this modifier should be used.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the bone density test is performed in conjunction with other procedures that are not typically reported together, to indicate that the procedures are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): If the same provider performs a repeat bone density test on the same day, this modifier should be used to indicate that the procedure was repeated.
5. Modifier 77 (Repeat Procedure by Another Physician): If a repeat bone density test is performed on the same day by a different provider, this modifier should be used.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although less common for imaging procedures, this modifier could be used if the test is repeated for clinical reasons on the same day to obtain additional information.
It is crucial to verify payer-specific guidelines as they may have unique requirements for the use of modifiers. Proper use of modifiers ensures compliance and optimizes reimbursement.
CPT code 77080 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement for this code, like others, is subject to specific coverage criteria and guidelines set forth by Medicare. It's important to note that the reimbursement rates and coverage policies can vary depending on the region, as they are administered by the respective Medicare Administrative Contractor (MAC) for each area. Healthcare providers should verify the specific reimbursement details and any local coverage determinations (LCDs) with their MAC to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 77080. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
