BMM Test
• 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.
o Contractors 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. Contractors are to maintain local lists of valid codes for the benefit’s screening categories.
o Contractors 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.
o Contractors 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.
o Contractors 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.
• Single photon absorptiometry tests are not covered. Contractors will deny CPT procedure code 78350.
