CPT 77086Radiology

Vrt fracture assmt via dxa

CPT 77086 covers vertebral fracture assessment (VFA) performed using dual-energy X-ray absorptiometry (DXA) equipment to detect compression fractures in the spine. This is typically done as an add-on to a bone density scan to check for existing vertebral fractures without additional radiation exposure.

Showing rates for

National Average

Base Medicare rate

$33.32

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

0.17

PE RVU (NF)

0.84

MP RVU

0.02

Total RVU

1.03

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill 77086 separately from bone density codes (77080, 77081, 77085) when VFA is performed and documented with distinct medical necessity
Impact: Captures additional $33.32 per study that is frequently missed when bundled incorrectly
Document specific clinical indications for VFA such as height loss >1.5 inches, kyphosis, glucocorticoid therapy >3 months, or prior fragility fracture
Impact: Reduces denial rate by 40-60% compared to studies without documented medical necessity
Ensure interpretation report separately addresses VFA findings with vertebral body labels (T4-L4) and fracture grading if present
Impact: Separate documentation supports distinct service and prevents downcoding or denial for lack of specificity
Verify that DXA equipment has lateral spine imaging capability and that both anteroposterior and lateral images are stored in patient record
Impact: Equipment capability audits can result in full recoupment if lateral imaging not documented or available
Do not bill 77086 on same day as separate thoracic or lumbar spine X-rays (72070-72074) without modifier to indicate distinct service
Impact: Bundling edits may result in automatic denial or reduction; modifier 59 may be required with documentation supporting separate medical necessity
Check individual payer VFA coverage policies as some commercial plans require prior authorization or limit frequency to every 2-3 years
Impact: Prior authorization compliance prevents 100% claim denials and patient balance billing issues

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 77086?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 77086 in 2025?

The 2025 Medicare national average payment rate for CPT 77086 is $33.32 for both facility and non-facility settings. This rate includes a work RVU of 0.17, practice expense RVU of 0.84, and malpractice RVU of 0.02, totaling 1.03 RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 77086 be billed with bone density codes 77080 or 77081?

Yes, CPT 77086 is separately reportable when billed with bone density codes 77080, 77081, or 77085 when medically necessary. VFA is not bundled with bone density measurement and should be billed as a distinct service when lateral spine imaging is performed, interpreted, and documented separately with appropriate clinical indication.

What are the medical necessity criteria for billing 77086?

Medical necessity for VFA typically includes documented height loss greater than 1.5 inches from peak, historical height loss greater than 2 cm, kyphosis on physical examination, long-term glucocorticoid therapy (>3 months at ≥5mg prednisone equivalent daily), age over 70 with low bone density, or prior fragility fracture. Screening without specific risk factors is generally not covered.

How often can CPT 77086 be billed for the same patient?

Medicare does not specify a national frequency limitation for 77086, but medical necessity must be documented for each service. Most clinical scenarios support VFA every 2-5 years unless interval clinical changes occur (new height loss, fracture event, or therapy change). Some commercial payers impose specific frequency limits requiring prior authorization for repeat studies.

What is the difference between CPT 77086 and spine X-rays?

CPT 77086 uses lateral images obtained during DXA bone density scanning specifically to assess vertebral fractures, while spine X-rays (72070-72074) are separate radiographic studies. VFA provides lower radiation exposure and is performed simultaneously with bone density testing. They should not typically be performed on the same day unless distinct clinical indications support both studies.

Do I need modifier 26 or TC when billing CPT 77086?

Use modifier 26 for professional component only (interpretation) when you don't own the equipment, or modifier TC for technical component only (equipment and technologist) when an outside physician interprets. Bill globally without modifiers when your practice provides both components. Splitting components is common in hospital outpatient and independent diagnostic testing facility settings.

What documentation is required in the interpretation report for CPT 77086?

The interpretation must include a separate section addressing VFA with vertebral levels assessed (T4 or T7-L4), image quality, presence or absence of fractures with specific vertebral body identification, fracture grading if present (mild/moderate/severe or Genant classification), and clinical correlation. This must be distinct from the bone density T-score reporting to support separate billing.