CPT 77090Radiology

Tbs techl prep&transmis data

CPT 77090 covers the technical work of preparing bone density measurement data and transmitting it electronically to a physician for interpretation. This is the technical component of trabecular bone score analysis, separate from the actual scan or professional interpretation.

Showing rates for

National Average

Base Medicare rate

$2.91

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

PE RVU (NF)

0.08

MP RVU

0.01

Total RVU

0.09

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify the primary DXA scan code (77080, 77081, or 77085) is billed first before appending 77090, as TBS requires a complete DXA dataset
Impact: Prevents automatic denials; 77090 alone without DXA will be rejected 95% of the time
Check payer coverage policies before billing 77090, as many commercial payers consider TBS investigational and do not reimburse separately beyond the base DXA payment
Impact: Avoids claim rework and identifies when advance beneficiary notice (ABN) is needed for patient billing
Document the specific TBS software version and vendor in the technical notes, as some payers require FDA-cleared TBS algorithms for reimbursement
Impact: Reduces denial rate by approximately 20-30% when payer requires proof of approved technology
Bill 77090 with the same date of service as the DXA scan (77080/77081), not the interpretation date, as it represents same-day technical work
Impact: Proper date alignment prevents timely filing denials and maintains $2.91 payment eligibility
Ensure the transmitting facility has a formal agreement or established protocol with the interpreting physician, as some payers audit transmission arrangements
Impact: Protects against post-payment recoupment in audits; documentation of relationship prevents clawbacks
Consider bundling negotiations with commercial payers if you perform high volumes, as the $2.91 Medicare rate is often not covered separately by commercial plans
Impact: Contract negotiations may yield $5-15 additional payment per study when bundled into DXA rates

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 77090?

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 CPT code 77090 used for?

CPT 77090 is used to bill for the technical work of preparing trabecular bone score (TBS) data from a DXA bone density scan and electronically transmitting it to a physician for interpretation. It captures the technical staff time and software processing required to generate TBS measurements from raw DXA images.

How much does Medicare pay for CPT 77090 in 2025?

Medicare pays $2.91 for CPT 77090 in 2025 under the national average non-facility rate. Both facility and non-facility rates are identical at $2.91, with total RVUs of 0.09 (0 work RVU, 0.08 PE RVU, 0.01 MP RVU).

Can CPT 77090 be billed alone without a DXA scan code?

No, CPT 77090 should not be billed independently. It requires a primary DXA bone density scan code (77080, 77081, or 77085) on the same date of service, as TBS analysis is derived from DXA imaging data and cannot exist without the base scan.

Do commercial insurance plans pay for CPT 77090?

Coverage varies significantly by payer. Many commercial plans consider trabecular bone score investigational and do not reimburse 77090 separately from the base DXA payment. Always verify coverage before performing the service and consider an advance beneficiary notice (ABN) when coverage is uncertain.

What modifiers are commonly used with CPT 77090?

Modifier 59 may be used to indicate a distinct service if bundling occurs inappropriately. Modifier 76 applies for repeat same-day transmission due to technical issues. Modifier TC is occasionally required by facility payers. Modifier 26 should never be used as 77090 is inherently a technical-only code.

What documentation is required to bill CPT 77090?

Documentation must include proof of TBS data preparation (software used, version, quality control), identification of the technical staff performing the work, and evidence of electronic transmission to the interpreting physician (transmission log, date/time, recipient confirmation). The documentation should link to the primary DXA study.

Is CPT 77090 covered by Medicare for osteoporosis screening?

Medicare coverage for 77090 depends on local coverage determinations (LCDs). While Medicare assigns a fee schedule rate of $2.91, not all Medicare Administrative Contractors (MACs) cover TBS as a separately payable service. Check your local MAC policy and be prepared for potential denials requiring appeal with medical necessity documentation.