MediCare Reimbursement By State for CPT Code 76078

The Medicare amounts above are effective as of January 1, 2004. To confirm rates for specific codes, please consult with the local carrier. Current Procedural Terminology (CPT) is copyright 2003 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

The Bone Mass Measurement Act
The Bone Mass Measurement Act, passed by Congress and signed by the President in 1997, mandated Medicare coverage for bone density testing beginning July 1, 1998.

All Medicare carriers and most private insurers cover biannual bone density testing for the following beneficiaries:

* A woman who is estrogen-deficient and at clinical risk for osteoporosis
* An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia or vertebral fracture
* An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to greater than or equal to 7.5 mg of prednisone per day for more than 3 months
* An individual with primary hyperparathyroidism
* An individual being monitored to assess the response to or efficacy of an FDA approved osteoporosis drug therapy

Eligible beneficiaries are able to have their bone mass tested once every two years, or more often, if medically necessary. Doctors are able to use all of the FDA-approved or cleared bone densitometry and sonometry devices that are currently available in the United States.