CPT 77080Radiology

Dxa bone density axial

CPT code 77080 covers a DXA (dual-energy X-ray absorptiometry) scan of the spine and hip to measure bone density and assess osteoporosis risk. This is the most common bone density test used to diagnose osteoporosis and predict fracture risk.

Showing rates for

National Average

Base Medicare rate

$38.17

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

0.2

PE RVU (NF)

0.96

MP RVU

0.02

Total RVU

1.18

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

NCCI bundling edits

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Billing tips

Verify Medicare frequency limits before scheduling - Medicare covers bone density testing once every 23 months for most beneficiaries, or more frequently if medically necessary
Impact: Prevents denials worth $38.17 per claim and reduces patient dissatisfaction from unexpected bills
Bill global code 77080 only when providing both technical and professional components; split using 26 and TC modifiers when components are separated
Impact: Incorrect component billing can result in overpayments requiring refunds or underpayments of 60-70% of expected reimbursement
Document qualifying diagnoses such as osteoporosis (M81.0), personal history of fracture (Z87.310), or long-term steroid use (Z79.52) to support medical necessity
Impact: Strong diagnosis coding reduces denial risk and supports coverage under Medicare's bone mass measurement benefit
Do not bill 77080 with peripheral bone density codes (77081, 76977) on the same date of service for the same patient
Impact: Unbundling violations can trigger full claim denial and potential audit flags
Issue an Advance Beneficiary Notice (ABN) when performing tests outside coverage parameters, and append modifier GA or GY appropriately
Impact: Proper ABN usage protects $38.17 in revenue by allowing patient billing when Medicare denies
Ensure DXA equipment meets FDA requirements and maintain calibration records - Medicare requires specific technical standards for coverage
Impact: Non-compliant equipment can result in retrospective denials and recoupment of all payments received

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77080 in 2025?

The 2025 Medicare national average payment for CPT 77080 is $38.17 for both facility and non-facility settings. This rate is based on 1.18 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by locality based on geographic practice cost indices (GPCI).

How often does Medicare cover bone density testing with CPT 77080?

Medicare covers bone density testing once every 23 months (approximately every 2 years) for eligible beneficiaries. More frequent testing may be covered if medically necessary, such as monitoring response to osteoporosis treatment, confirming initial diagnosis, or after fracture. Documentation must support the medical necessity for accelerated frequency.

What is the difference between CPT 77080 and 77081?

CPT 77080 is for DXA bone density measurement of the axial skeleton (spine and/or hip), while CPT 77081 is for DXA measurement of appendicular skeleton (peripheral sites like forearm or heel). Code 77080 is the preferred Medicare-covered screening test as axial measurements are more predictive of fracture risk. These codes should not be billed together on the same date of service.

Do I need modifier 26 or TC when billing CPT 77080?

Use modifier 26 when billing only the professional component (physician interpretation). Use modifier TC when billing only the technical component (equipment and technologist). Bill the global code 77080 without modifiers only when your facility provides both components. Splitting components incorrectly can result in overpayment or underpayment.

What diagnosis codes support medical necessity for CPT 77080?

Common supporting diagnosis codes include Z13.820 (encounter for screening for osteoporosis), M81.0 (age-related osteoporosis without fracture), Z87.310 (personal history of fracture), Z79.52 (long-term use of systemic steroids), E28.310 (premature menopause), and M80.0- series (osteoporosis with fracture). Documentation must support the risk factors or screening indication.

Can CPT 77080 be billed for men or only postmenopausal women?

CPT 77080 can be billed for both men and women when medically necessary. While Medicare coverage focuses on postmenopausal women and patients with specific risk factors, men with osteoporosis risk factors (corticosteroid use, hypogonadism, previous fracture, age >70) also qualify. Documentation must support medical necessity regardless of gender.

What are the RVU values for CPT 77080 in 2025?

The 2025 RVU values for CPT 77080 are: Work RVU 0.2, non-facility PE RVU 0.96, facility PE RVU 0.96, and MP RVU 0.02, for a total of 1.18 RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A file released December 23, 2024.