CPT 77091Radiology

Tbs techl calculation only

CPT code 77091 covers the technical calculation of trabecular bone score (TBS), a specialized analysis that evaluates bone quality and fracture risk using existing bone density scan images.

Showing rates for

National Average

Base Medicare rate

$26.52

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)

0.81

MP RVU

0.01

Total RVU

0.82

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

NCCI bundling edits

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Billing tips

Always verify that your TBS software is FDA-cleared and specifically designed for the calculation represented by 77091
Impact: Non-compliant software can result in 100% denial and potential recoupment of all claims
Bill 77091 only when TBS calculation is performed on the same date as the underlying DEXA scan (typically 77080 or 77085)
Impact: Standalone billing without corresponding bone density study will be denied; ensure date of service matches
Document that TBS analysis was ordered by the treating physician and that results are included in the patient's medical record
Impact: Medical necessity documentation prevents denial and supports the full $26.52 reimbursement
Check payer-specific policies as many commercial insurers do not cover TBS calculation, requiring patient self-pay
Impact: Medicare pays $26.52 but many payers deny; obtain ABN or patient agreement to avoid write-offs
Ensure the lumbar spine DEXA images are of adequate quality for TBS calculation; poor image quality invalidates the analysis
Impact: Quality issues can lead to non-payable repeat procedures or denials for service not rendered as specified
Report 77091 with Place of Service code consistent with where the DEXA equipment is located (typically POS 22 or 11)
Impact: Incorrect POS can trigger review or denial; both facility and non-facility rates are $26.52 for this code

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Frequently asked questions

What is CPT code 77091 used for?

CPT 77091 is used to bill for the technical calculation of trabecular bone score (TBS), a specialized analysis that evaluates bone quality and microarchitecture using existing DEXA scan images. It provides additional fracture risk information beyond standard bone mineral density measurements and is billed as an add-on to bone density studies.

How much does Medicare pay for CPT 77091 in 2025?

Medicare pays $26.52 for CPT 77091 in 2025 under the national average rate for both facility and non-facility settings. The code has a total RVU of 0.82, consisting of 0.81 practice expense RVU and 0.01 malpractice RVU, with no work RVU component since it represents technical calculation only.

Can CPT 77091 be billed alone or does it require another code?

CPT 77091 should not be billed alone. It is an add-on service that must be paired with a bone density study code such as 77080, 77085, or 77086 performed on the same date of service. The TBS calculation is a post-processing analysis applied to DEXA images and requires a base bone density procedure to have clinical relevance.

What modifiers should be used with CPT 77091?

CPT 77091 typically requires modifier TC to indicate the technical component, though the code is inherently technical-only. Modifier 59 may be needed to indicate a distinct procedural service if bundling edits occur. Modifier 26 should never be used as there is no professional component for this calculation-only code.

Do all insurance companies cover CPT 77091?

No, coverage for CPT 77091 varies significantly by payer. While Medicare covers TBS calculation at $26.52 when medically necessary, many commercial insurers consider it investigational or not medically necessary and deny coverage. Providers should verify coverage before performing the service and obtain an Advance Beneficiary Notice (ABN) or patient agreement for self-pay when coverage is uncertain.

What documentation is needed to support billing CPT 77091?

Documentation must include a physician order specifically requesting TBS calculation, clinical indication for the analysis (such as borderline bone density or secondary osteoporosis risk factors), confirmation that FDA-cleared TBS software was used, the numerical TBS result, technologist identification, and verification that the calculation was performed on the same date as the DEXA scan with adequate image quality.

What is the difference between CPT 77091 and bone density codes like 77080?

CPT 77080 represents a complete bone density study including acquisition of DEXA images and physician interpretation of bone mineral density results. CPT 77091 is an additional technical calculation that analyzes the texture and microarchitecture quality of bone from those same DEXA images to generate a trabecular bone score. The 77091 calculation is supplemental to, not a replacement for, the standard bone density measurement.