CPT 77089Radiology

Tbs dxa cal w/i&r fx risk

CPT 77089 covers trabecular bone score (TBS) analysis performed on existing bone density (DXA) scans to better assess fracture risk beyond what standard bone density alone reveals. This computer-aided analysis evaluates bone quality and microarchitecture using advanced imaging interpretation.

Showing rates for

National Average

Base Medicare rate

$38.82

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)

0.97

MP RVU

0.03

Total RVU

1.2

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

NCCI bundling edits

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Billing tips

Bill 77089 only when separate TBS interpretation and report is generated in addition to standard DXA report
Impact: Prevents denials for lack of documentation; missing separate TBS report results in 100% claim denial
Verify TBS software is FDA-cleared and licensure is current before billing, as payers require documented TBS-specific technology
Impact: Unlicensed or expired software results in denial of all claims until compliance documented
Do not bill 77089 on same date as initial DXA interpretation training or quality control procedures
Impact: Billing for QC/training scans triggers fraud alerts and potential 100% recoupment
Document medical necessity for TBS beyond standard BMD, such as diabetes, prior fracture, or glucocorticoid use in patient history
Impact: Medical necessity documentation prevents 30-40% of denials for 'not medically necessary' determinations
Ensure TBS analysis is performed on L1-L4 lumbar spine images from same DXA study as bone density, not as standalone
Impact: Standalone TBS without concurrent DXA typically denied; must reference parent DXA study order
Check individual payer policies as many commercial payers consider TBS experimental/investigational despite CPT code existence
Impact: Medicare and some commercial payers reimburse at $38.82, but 60-70% of commercial payers may deny as non-covered

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77089 in 2025?

The 2025 Medicare national average payment for CPT 77089 is $38.82 for both facility and non-facility settings. This is based on 1.2 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 77089 be billed with standard DXA codes like 77080 or 77081?

Yes, CPT 77089 is designed to be billed in addition to standard DXA bone density codes (77080, 77081) when trabecular bone score analysis is performed on the same study. However, a separate TBS interpretation and report must be documented to justify billing both codes together.

Do all insurance companies cover CPT code 77089 for trabecular bone score?

No, coverage varies significantly by payer. Medicare recognizes and reimburses CPT 77089, but many commercial insurance companies still consider TBS experimental or investigational and deny coverage. Verify individual payer policies before performing the service and consider obtaining an advance beneficiary notice (ABN) when coverage is uncertain.

What documentation is required to bill CPT 77089 successfully?

Required documentation includes a separate TBS interpretation report with the numeric TBS value, quality grade, fracture risk assessment, clinical correlation, and physician signature. The report must be distinct from the standard DXA interpretation and reference the TBS-certified software used and the lumbar spine images analyzed.

How often can CPT 77089 be billed for the same patient?

Frequency depends on payer policy, but generally TBS should be billed no more frequently than standard DXA scanning (typically every 2 years for monitoring). More frequent billing requires documentation of significant clinical changes such as new fractures, medication changes, or other factors affecting bone health that justify earlier reassessment.

What are the RVU values for CPT 77089 in 2025?

For 2025, CPT 77089 has a work RVU of 0.2, practice expense RVU of 0.97 (both facility and non-facility), malpractice RVU of 0.03, totaling 1.2 RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Is special equipment or software required to bill CPT 77089?

Yes, billing CPT 77089 requires FDA-cleared TBS software specifically licensed and installed on your DXA system. The software performs texture analysis of lumbar spine DXA images to calculate the trabecular bone score. Simply having DXA equipment without TBS-certified software is insufficient to bill this code.