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US reimbursement
A game-changer in osteoporosis care
Trabecular Bone Score® is reimbursed in the US under four dedicated CPT® Category I codes, billable alongside DXA. Here's how it works.
Original Medicare routinely reimburses TBS® procedures. Coverage may vary by payer, plan, and region.
Overview
Reimbursed and growing fast
The first reimbursable CPT® codes for Trabecular Bone Score® became effective in the USA on 1 January 2022, a significant step forward in osteoporosis care. TBS® benefits from four dedicated CPT® Category I codes, priced by CMS under the Physician Fee Schedule and the Outpatient Prospective Payment System (OPPS).
Based on recent Medicare claims data, TBS® utilisation in the US has approximately doubled each year since 2022.
The codes
Four dedicated CPT® Category I codes
CPT CODE
DESCRIPTION
77089
TBS® structural condition of bone microarchitecture; using DXA or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture risk
77090
TBS®; technical preparation and transmission of data for analysis to be performed elsewhere
77091
TBS®; technical calculation only
77092
TBS®; interpretation and report on fracture risk only, by other qualified health care professional
The AMA standard
Meeting the AMA's highest standards
The AMA reserves Category I codes for procedures meeting strict criteria for clinical acceptance and efficacy. TBS® satisfies all of them:
✓
FDA-cleared device: The devices needed to perform the procedure have FDA clearance or approval
✓
Widely performed: Carried out by many qualified US healthcare professionals
✓
High volume: Frequently performed in line with its intended clinical use
✓
Standard of care: Consistent with current medical practice
✓
Evidence-based: clinical efficacy documented in literature meeting CPT® application requirements
FAQ
Coding & billing questions
Do TBS® codes replace BMD DXA codes?
No. TBS® codes are independent and are billed in addition to BMD DXA codes. The combination increases total reimbursement.
Do TBS® codes replace BMD DXA codes?
DXA BMD codes use -26 and -TC modifiers to separate professional and technical components, but TBS® uses four separate codes for each component instead. Do not append -26 or -TC modifiers to TBS® codes, as it can result in payment denial.
Our outpatient facility uses split billing. Which codes should we use?
Use 77091 for the technical component and 77092 for the professional charge. Note: 77089 and 77092 contain a professional component and are paid only under the PFS (not OPPS).
What's the difference between 77091 and 77090?
Both describe technical components:
77091: The TBS® calculation (the standard code when the DXA device is equipped with TBS®)
77090: Only used when image data is extracted and sent elsewhere for computation (a rare occasion)
Reimbursement resource
The TBS reimbursement and coding guide
- Appropriate procedure-code selection for TBS®
- Detailed descriptions of each code
- Reporting requirements
TBS Osteo™ is intended exclusively for healthcare professionals and is not available for purchase by the general public. TBS Osteo is a Class IIa medical device, CE marked under EU MDR 2017/745 (CE 2460). TBS Osteo is FDA 510(k) cleared (K243218) for use in the United States. TBS Osteo is included on the Australian Register of Therapeutic Goods (ARTG No. 528950) as "Inovanz Pty Ltd — X-ray system, diagnostic, general-purpose, application program software". Manufacturer: Medimaps Group SA, Chemin du Champ-des-Filles 36A, 1228 Plan-les-Ouates, Geneva, Switzerland. Always follow the instructions for use.