A game-changer in osteoporosis care
The first reimbursable CPT® codes1 for Trabecular Bone Score (TBS) assessment became effective in the USA on January 1, 2022, marking a significant step forward in the care for osteoporosis. TBS benefits from 4 dedicated CPT® Category I codes and is priced by CMS (Center for Medicare and Medicaid Services) under the Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS).
The national average payment rate for a TBS procedure on the PFS is $40.28, and $86.58 for OPPS2.
| CPT codes | Description |
|---|---|
| 77089 | Trabecular Bone Score (TBS) structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk. |
| 77090 | Trabecular Bone Score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere. |
| 77091 | Trabecular Bone Score (TBS), structural condition of the bone microarchitecture; technical calculation only. |
| 77092 | Trabecular Bone Score (TBS), structural condition of the bone microarchitecture; interpretation and report on fracture-risk only by other qualified health care professional. |
Meeting the highest standard set by the American Medical Association
The American Medical Associations (AMA) reserves Category I codes for procedures that meet strict criteria regarding their clinical acceptance and efficacy. The assignment of Category I codes recognizes that TBS satisfies all of the following requirements3 :
- Devices necessary to perform the procedure have received FDA clearance or approval.
- The procedure is performed by many qualified healthcare professionals in the United States.
- It is frequently performed in line with its intended clinical use “(i.e., a service for a common condition should have high volume)”.
- It is consistent with current medical practice.
- Its clinical efficacy is documented in literature that meets CPT® code application requirements.
Reimbursement resource center
Original Medicare routinely reimburses TBS procedures, benefiting both healthcare providers and patients. Coverage through other payers may vary depending on plan and region.
New to TBS? We provide comprehensive professional services to support you on reimbursement. Explore our educational programs, billing and coding guides, and other resources to assist you with TBS reimbursement.
TBS reimbursement
and coding guide
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FAQs
No. TBS Codes do not replace BMD DXA codes. They are independent codes and can be billed in addition to BMD. The combination of the two procedures increases total reimbursement.
While DXA BMD codes use modifiers -26 and -TC to separate professional and technical components, TBS uses 4 different codes for each component. Do not append -26 or -TC modifiers to TBS codes. This can result in payment denial.
Use code 77091 to bill for the technical component, and 77092 for the professional charge. 77090 is only used in rare instances (refer to the next question below).
Codes 77089 or 77092 cannot be used to bill for services under the Outpatient Prospective Payment System (OPPS) as they contain a professional component and are not assigned to any APC. They are only paid under the Physician Fee Schedule (PFS).
Both codes describe technical components of TBS:
- 77091 – Accounts for the TBS calculation and is the standard code used when the DXA device is equipped with TBS.
- 77090 – Only used when image data is extracted from the modality and sent elsewhere for a TBS computation. This is a rare occasion.
Contact us
For more information regarding TBS reimbursement, please contact our reimbursement specialists at reimbursement@medimapsgroup.com. Do not send any patient information or other Protected Health Information (PHI). Medimaps will not process requests containing PHI.
1. Current Procedural Terminology.
2.Updated information as of Sptember 2024. Medimaps cannot guarantee medical benefit coverage or reimbursement based on the codes listed in this page. This page is for informational purposes only. OPPS fee listed is for the technical component only. The physician fee for the interpretation is $9.65.
3. https://www.ama-assn.org/practice-management/cpt/criteria-cpt-category-i-and-category-iii-codes.
