Medicare policy of bone mass measurement billing

Bone Mass Measurement for Medicare

The services described in Oxford policies are subject to the terms, conditions and limitations of the Member's contract or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage enrollees. Oxford reserves the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies as well as SecureHorizons and Evercare 

Certain policies may not be applicable to Self-Funded Members and certain insured products. Refer to the Member's plan of benefits or Certificate of Coverage to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the Member’s plan of benefits or Certificate of Coverage, the plan of benefits or Certificate of Coverage will govern. 

Policy #: RADIOLOGY 007.14 T0
Coverage Statement: Policy is applicable to:
    AARP MedicareComplete, Evercare Plan DH and SecureHorizons MedicareComplete, including Group Retiree Plans underwritten by Oxford Health Plans (NY/NJ/CT), Inc. (CMS Contract Numbers: H0752, H3107 and H3307)
For Commercial plans, refer to policy: Photon Absorptiometry and Collagen Crosslinks. Conditions of Coverage
Benefit Type General benefits package
Referral Required
(Does not apply to non-gatekeeper products)
Authorization (Precertification always required for inpatient admission) No
Precertification with MD Review No
Site(s) of Service
(If not listed, MD Review required)
Outpatient, Office
Description of Service/Assessment/Background Information:
Bone mass measurement (BMM) studies are radiologic, radioisotopic or other procedures that meet all of the following conditions:
  • quantify bone mineral density, detect bone loss or determine bone quality;
  • are performed with either a bone densitometer (other than single-photon or dual-photon absorptiometry) or a bone sonometer system that has been cleared or approved for marketing for BMM by the Food and Drug Administration (FDA);
  • include a physician's interpretation of the results.
The following procedures are used to measure bone mineral density:
  • dual energy x-ray absorptiometry (DXA)
  • radiographic absorptiometry (RA)
  • bone sonometry (ultrasound)
  • single energy x-ray absorptiometry (SEXA)
  • quantitative computed tomography (QCT)
Earlier technologies, such as single and dual photon absorptiometry, are no longer used.

No comments:

Top Medicare billing tips