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US reimbursement
A game-changer in osteoporosis care
Trabecular Bone Score® is reimbursed in the US under four dedicated CPT® Category I codes, billable alongside DXA. Here's how it works.
Original Medicare routinely reimburses TBS® procedures. Coverage may vary by payer, plan, and region.
Overview
Reimbursed and growing fast
The first reimbursable CPT® codes for Trabecular Bone Score® became effective in the USA on 1 January 2022, a significant step forward in osteoporosis care. TBS® benefits from four dedicated CPT® Category I codes, priced by CMS under the Physician Fee Schedule and the Outpatient Prospective Payment System (OPPS).
Based on recent Medicare claims data, TBS® utilisation in the US has approximately doubled each year since 2022.
The codes
Four dedicated CPT Category I codes
CPT CODE
DESCRIPTION
77089
TBS® structural condition of bone microarchitecture; using DXA or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture risk
77090
TBS®; technical preparation and transmission of data for analysis to be performed elsewhere
77091
TBS®; technical calculation only.
77092
TBS®; interpretation and report on fracture risk only, by other qualified health care professional
The AMA standard
Meeting the AMA's highest standard
The AMA reserves Category I codes for procedures meeting strict criteria for clinical acceptance and efficacy. TBS® satisfies all of them:
✓
FDA-cleared device: The devices needed to perform the procedure have FDA clearance or approval
✓
Widely performed: Carried out by many qualified US healthcare professionals
✓
High volume: Frequently performed in line with its intended clinical use
✓
Standard of care: Consistent with current medical practice
✓
Evidence-based: clinical efficacy documented in literature meeting CPT® application requirements
FAQ
Coding & billing questions
Do TBS® codes replace BMD DXA codes?
No. TBS® codes are independent and are billed in addition to BMD DXA codes. The combination increases total reimbursement.
Do TBS® codes replace BMD DXA codes?
DXA BMD codes use -26 and -TC modifiers to separate professional and technical components, but TBS® uses four separate codes for each component instead. Do not append -26 or -TC modifiers to TBS® codes, as it can result in payment denial.
Our outpatient facility uses split billing. Which codes should we use?
Use 77091 for the technical component and 77092 for the professional charge. Note: 77089 and 77092 contain a professional component and are paid only under the PFS (not OPPS).
What's the difference between 77091 and 77090?
Both describe technical components:
77091: The TBS® calculation (the standard code when the DXA device is equipped with TBS®)
77090: Only used when image data is extracted and sent elsewhere for computation (a rare occasion)