CPT Code 77080 is the billing code for DXA scans. This test measures bone density and helps detect conditions like osteoporosis early, since accurate coding is essential for timely reimbursement and proper insurance coverage.
However, understanding CPT 77080 is vital for both healthcare providers and medical billers. In this guide, we’ll break down what CPT Code 77080 means, its role in DXA scan billing, and key tips to avoid costly claim denials.
What is CPT Code 77080?
CPT Code 77080 is the medical billing code for a central DXA (Dual-Energy X-ray Absorptiometry) scan, which measures bone density in key areas like the spine, hip, or pelvis. These regions provide the most accurate picture of bone strength, helping doctors diagnose osteoporosis and monitor treatment effectiveness.
How It’s Different from Other DXA Codes
To avoid confusion, it’s essential to know how CPT 77080 differs from related DXA codes:
- 77081: density scan for smaller areas (wrist, heel, forearm).
- 77085: Bone density test plus a vertebral fracture assessment.
- 77086: Vertebral fracture assessment performed alone.
Selecting the correct code is critical not only for accurate documentation but also for smooth insurance approvals and timely reimbursement.
When Do Doctors Use CPT Code 77080?
The CPT Code 77080 bone density scan (DXA scan for axial skeleton) is used in several clinical situations, especially when Medicare coverage criteria are met.
Doctors commonly order it for:
- Screening for osteoporosis in postmenopausal women or patients with risk factors (long-term steroid use, family history of fractures, or vertebral abnormalities).
- Assessing fracture risk, especially in older adults, to prevent costly fractures.
- Monitoring treatment response in patients receiving osteoporosis medication or lifestyle interventions.
Medicare Coverage Note: Medicare Part B covers bone mass measurements (including tests billed under CPT 77080) once every 24 months for eligible patients, such as those with risk factors or when being monitored for treatment effectiveness. You pay nothing if the provider accepts the assignment.
CPT Code 77080 vs Other DXA Codes (with Real-World Relevance)
Here’s how CPT Code 77080 compares with related DXA codes, plus how that impacts billing and reimbursement:
| Code | Region Scanned | When It’s Used | Medicare Frequency / Coverage Notes |
| 77080 | Spine, hips (axial skeleton) | Standard for central bone density scans; often used for osteoporosis diagnosis and monitoring. | Covered by Medicare every 24 months for eligible patients. Proper documentation of risk factors & medical necessity required. |
| 77081 | Peripheral bones (wrist, heel, forearm) | Used when an axial scan isn’t possible or desired; lower priority for fracture risk in the central skeleton. | Less common; payers often expect justification, and reimbursement may differ. |
| 77085 | Axial skeleton + vertebral fracture assessment | Used when a fracture check is combined with the density scan (adds diagnostic value). | Requires added documentation; reimbursement may be higher due to extra assessment. |
| 77086 | Vertebral fracture assessment alone | When just the fracture check is needed, without a full axial density scan. | Must clearly document the reason for the fracture assessment. |
Using the correct code (e.g., 77080 vs 77081) and including required documentation (age, risk factors, indication) helps with Medicare reimbursement under CPT Code 77080 reimbursement Medicare policies, and reduces denials.
Reimbursement and Insurance Coverage
Medicare Coverage (77080 CPT Code Reimbursement Medicare):
Medicare Part B usually covers one central DXA scan (77080) every 24 months for eligible patients. Coverage may be more frequent if the patient has specific risk factors, such as:
- Long-term corticosteroid therapy
- Primary hyperparathyroidism
- Radiographic evidence of vertebral abnormalities
- Postmenopausal women at risk of osteoporosis
- Monitoring response to FDA-approved osteoporosis treatment
Providers must document the medical necessity to ensure Medicare reimbursement.
Private Insurance:
Commercial insurers often follow Medicare’s coverage frequency but may impose prior authorization requirements. Always confirm eligibility and payer-specific rules to avoid denials.
Key to Payment Success:
- Clear documentation of medical necessity
- Correct CPT/ICD-10 coding
- Following insurer rules on scan frequency
Documentation & Billing Best Practices
To get consistent reimbursement for CPT Code 77080 bone density scans, providers should:
Document Clinical Necessity: Clearly state why the DXA scan was needed (osteoporosis, fracture risk, or treatment monitoring).
Use Standard ICD-10 Codes:
- M80–M81: Osteoporosis (with/without fracture)
- Z13.820: Screening for osteoporosis
Apply Correct Modifiers: Use modifier -26 (professional component) or -TC (technical component) when applicable.
Reduce Denials by:
- Verifying coverage & frequency limits before scheduling
- Aligning ICD-10 codes with medical records
- Submitting electronic claims promptly
Explore our medical billing services at Resilient MBS, your trusted partner in compliance, accuracy, and maximum reimbursement.
Common Reasons for Denials and How to Improve Reimbursement
Even though DXA scans are routine, CPT Code 77080 claims face some of the highest denial rates in diagnostic imaging. Studies show advanced imaging, including DXA, averages a 24% denial rate, compared to just 12% for other diagnostics, and as many as 90% of these denials are preventable.
Common Reasons for Denials
- Lack of Medical Necessity: Patient records lack clear justification for the scan’s necessity (e.g., osteoporosis risk, steroid use, vertebral abnormality).
- Incorrect or Missing ICD-10 Codes: Using non-specific or mismatched diagnosis codes (e.g., M80–M81 or Z13.820 not documented).
- Frequency Issues: Performing scans more often than allowed (Medicare usually covers one every 24 months unless a higher risk is documented).
- Payer-Specific Rules Ignored: Failure to follow requirements for prior authorization or payer documentation updates.
How to Improve Reimbursement
- Verify Coverage & Frequency: Confirm Medicare/private payer timelines before scheduling.
- Align ICD-10 Codes with Records: Ensure documented medical necessity matches submitted codes.
- Apply Correct Modifiers: Use -26 (professional component) and -TC (technical component) correctly when billing.
- Use Connected Systems: Linking EMRs with billing platforms cuts coding errors and ensures cleaner claims.
- Train Staff & Track Denials: Ongoing training and denial trend analysis help spot recurring issues before they impact revenue.
Upcoming Developments in DXA Scan Billing
As healthcare shifts toward value-based care, preventive tests like DXA scans are expected to receive greater reimbursement emphasis. Emerging technologies such as:
- AI-powered coding tools (reduce manual errors)
- Stronger EHR-billing integrations (improve documentation flow)
- Regular coding updates (stay aligned with payer requirements) will make billing smoother, more accurate, and less prone to denials.
Bottom Line: Providers who document necessity, follow payer rules, and embrace technology can significantly improve Medicare and private payer approval rates for the 77080 CPT code reimbursement.
Final Words
CPT Code 77080 is a critical tool in diagnosing osteoporosis and preventing fractures through DXA bone density scans. For providers, accurate documentation, proper ICD-10 coding, and compliance with payer frequency rules are the keys to avoiding denials and ensuring smooth reimbursement.
Staying updated on coding changes, training staff regularly, and using integrated EMR–billing systems can significantly reduce claim errors. By combining clinical accuracy with billing expertise, healthcare practices can improve both patient outcomes and financial health.
If your practice needs expert guidance to simplify bone density scan billing and reduce denials, explore our medical billing services at Resilient MBS, your trusted partner in compliance, accuracy, and maximum reimbursement.
FAQs
What is CPT Code 77080?
CPT Code 77080 is the billing code for a DXA bone density scan of the spine and hips. It helps doctors evaluate bone strength and detect conditions such as osteoporosis.
How is CPT Code 77080 different from 77081?
CPT 77080 is used for central scans of the axial skeleton (spine, hips, pelvis), while CPT 77081 is for peripheral scans of smaller bones like the wrist, forearm, or heel.
Does Medicare pay for CPT Code 77080?
Yes. Medicare Part B usually covers a 77080 DXA scan once every 24 months if you meet specific risk criteria (e.g., postmenopausal women, long-term steroid therapy, vertebral abnormalities, or monitoring osteoporosis treatment).
What information is needed to bill CPT Code 77080?
Providers must include a physician order, the correct ICD-10 diagnosis code (e.g., M80, M81, Z13.820), and a clear scan report that justifies medical necessity.
How much does Medicare reimburse for CPT Code 77080?
Reimbursement typically ranges between $40 and $60, though exact amounts vary by state and payer policy. Always confirm with Medicare’s current fee schedule or the local MAC (Medicare Administrative Contractor).
