CPT 76977Radiology

Us bone density measure

CPT 76977 covers ultrasound bone density measurement, a non-invasive screening test that uses sound waves to assess bone strength and fracture risk, typically performed on the heel or other peripheral bones.

Showing rates for

National Average

Base Medicare rate

$7.12

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.05

PE RVU (NF)

0.15

MP RVU

0.02

Total RVU

0.22

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify medical necessity before performing - Medicare covers bone density studies (including 76977) once every 23 months for qualified patients, not as frequently as DEXA
Impact: Prevents $7.12 denial and patient satisfaction issues; frequency limitations are strictly enforced
Consider using ABN (modifier GA) for patients who don't meet Medicare coverage criteria but request the screening
Impact: Allows collection of full $7.12 from patient when Medicare denies; protects revenue
Document the specific anatomical site measured (calcaneus, tibia, phalanges) and laterality in the report
Impact: Reduces audit risk and supports medical necessity; missing site documentation is a common reason for payment recoupment
Do not bill 76977 on the same day as DEXA scans (77080, 77081, 77085, 77086) for the same patient without clear separate medical indication
Impact: High bundling risk; payers typically deny 76977 as inclusive or redundant when DEXA is performed
Bill the global code (no modifier) when your facility owns equipment and provides interpretation - splitting with 26/TC reduces already minimal reimbursement
Impact: Maximizes the $7.12 payment by avoiding payment splits; critical for low-value codes
Track total RVUs (0.22) for MIPS reporting but recognize this code contributes minimally to quality measure denominators
Impact: Understand that high volume of 76977 alone will not significantly impact MIPS performance scores

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76977 in 2025?

The 2025 Medicare national average reimbursement for CPT 76977 is $7.12 for both facility and non-facility settings, based on a total RVU of 0.22 and conversion factor of 32.3465.

How often can CPT 76977 be billed to Medicare?

Medicare covers bone density testing, including 76977, once every 23 months (nearly two years) for qualified beneficiaries. More frequent testing requires exceptional documentation of significant clinical change or new therapy initiation.

Can CPT 76977 be billed with a DEXA scan on the same day?

Generally no. Medicare and most payers consider ultrasound bone density (76977) and DEXA scans (77080, 77081) performed on the same date as duplicative services. One will typically be denied unless there is clear documentation of separate medical necessity for different anatomical assessments.

What is the difference between CPT 76977 and DEXA bone density codes?

CPT 76977 is ultrasound-based bone density measurement performed on peripheral sites like the heel, while DEXA codes (77080, 77081, 77085, 77086) use X-ray technology to measure central sites like spine and hip. DEXA is the gold standard for osteoporosis diagnosis; 76977 is primarily a screening tool.

Do I need an ABN for CPT 76977 if the patient doesn't meet frequency requirements?

Yes. If testing is performed before 23 months have elapsed since the last bone density study, or if the patient doesn't meet Medicare coverage criteria, an Advance Beneficiary Notice (ABN) should be obtained and modifier GA appended to allow patient billing after Medicare denial.

What documentation is required to bill CPT 76977?

Required documentation includes the specific anatomical site measured, laterality, quantitative measurements, interpretation of bone health status, physician signature and date, and clinical indication justifying medical necessity. Missing any element increases audit and denial risk.

Who can perform and bill for CPT 76977?

CPT 76977 can be billed by physicians and qualified healthcare facilities with appropriate ultrasound bone density equipment. The test may be performed by trained technologists, but interpretation must be provided by a physician or qualified non-physician practitioner. Radiology, primary care, rheumatology, endocrinology, and orthopedic practices commonly bill this code.