Humana Commercial Clinical Policy

Humana Bone Density Measurement Form

Effective Date

01/01/2024

Last Reviewed

NA

Original Document

  Reference



Description

Osteoporosis is a disease in which bones become brittle or fragile from loss of tissue. It may be related to aging, associated with certain medical conditions or a result of pharmacotherapy. If osteoporosis is undetected and left untreated, loss of bone mass may result in fractures.

Measurement of bone mineral density (BMD) may be utilized for the diagnosis and treatment of decreased bone mass. There are a variety of techniques designed for aiding in this measurement. These include, but may not be limited to:

  • Dual-energy X-ray absorptiometry (DXA) is the best available clinical tool for the diagnosis of osteoporosis and monitoring changes in bone mineral density over time. DXA sends two types of energy level X-ray beams which are absorbed differently by bones and soft tissue. Strong, dense bones allow less of the X-ray beam to pass through them. The density profiles from these X-rays are used to calculate BMD. The lower the density, the greater risk of fracture. Results are presented as T-scores, which are the number of standard deviations (units) that bone density is above or below the average for a healthy adult or as Z-scores, which compares the bone density to an average individual of the same age as the individual tested. Central DXA scans consist of a large, flat table with a radiographic arm suspended overhead. Peripheral DXA (pDXA) devices are portable instruments that use the same DXA technology, however measure bone density via the heel, wrist or finger.
  • Vertebral fracture assessment (VFA) is a test that is performed at the same time as a central DXA scan. It is used to identify previously undetected vertebral compression fractures and evaluate the risk for future fractures. While this test does not measure bone density, the presence of vertebral factors can indicate a higher risk of fractures elsewhere in the body and may change diagnostic classification or clinical management.
  • Whole body DXA is a method purported to determine body composition, by measuring the relative proportions of fat and lean mass in the body. Lean mass refers to bones, muscles, organs and tissues. This testing is typically confined to clinical or research settings when a more rigorous determination of body composition is needed. (Refer to Coverage Limitations section)
  • Artificial intelligence (AI) technology purported to identify vertebral compression fractures by utilizing automated analysis during computed tomography (CT) scanning of the abdomen/chest or osteoporosis/osteopenia from digital X-ray radiogrammetry via a cloud-based screening method are other possibilities being explored for assessing bone disease. The Nanox.AI and OsteoApp.ai are examples. (Refer to Coverage Limitations section)
  • Bone turnover markers (BTM)/biochemical markers are laboratory-based tests of serum or urine, purported to measure the rate of bone loss. Biochemical markers of bone turnover are products released from osteoblasts and osteoclasts or collagen breakdown products. C-telopeptide crosslink (CTX), N-telopeptide crosslink (NTX) and pyridinium crosslinks (PYD/DPD) are markers of bone resorption. Bone-specific alkaline phosphatase (BSAP/BALP), osteocalcin (OC) and procollagen type I propeptides (C-terminal [PICP] and N-terminal [PINP]) are markers of bone formation.

Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.formation. Assay variability and poor standardization have limited the use of BTMs in clinical practice.49 (Refer to Coverage Limitations section)

Dual-photon absorptiometry (DPA) and single-photon absorptiometry (SPA) are older methods of testing purported to measure bone density using a photon beam at one or two distinct energy levels. These two tests have been replaced by DXA, due to improved accuracy. (Refer to Coverage Limitations section)

Microindentation of the tibia is a suggested bone density test utilizing a device that invasively indents the tibia bone to produce microfractures. If the microfractures occur easily, the probe indents deeper and the resulting bone quality score is lowered. An example of this type of device is the OsteoProbe. (Refer to Coverage Limitations section)

Pulse-echo ultrasound is a test in which a small, handheld device is used to purportedly measure cortical bone thickness of the tibia. Bindex is an example of this device. (Refer to Coverage Limitations section)

Radiofrequency echographic multi-spectrometry (REMS) is a portable, radiation-free technology that is being investigated as a potential alternative for assessing bone density and quality on the lumbar vertebrae and proximal femur. Bone microarchitecture is characterized using radiofrequency signals acquired during an ultrasound scan. This has been created in an effort to overcome some of the limitations of DXA. An example of this technology is the EchoS . (Refer to Coverage Limitations section)

Quantitative computed tomography (QCT) is a test intended to distinguish trabecular bone (soft bone) from cortical bone (hard bone) to measure BMD of the proximal femur or spine. Peripheral QCT (pQCT) measures the same at the radius or tibia. The CliniQCT and QCT Pro is a type of software that purportedly allows for the measurement of BMD at the same time any non-IV contrast abdominal or pelvic CT has been performed for another purpose.VirtuOst, is another type of QCT, which also uses data from previously acquired CT scans (known as Biomechanical Computed Tomography [BCT] analysis) through finite element analysis (FEA). FEA uses computer models of images as well as data from QCT to assess bone strength, bone mineral density, classification of anyBone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Quantitative ultrasound densitometry (QUS) is proposed to measure BMD using speed of sound (SOS) and/or broadband ultrasound attenuation (BUA) at the heel, tibia, patella and other peripheral skeletal sites. It is suggested that a composite parameter using SOS and BUA may be used clinically. (Refer to Coverage Limitations section)

Single-energy X-ray absorptiometry (SEXA, SXA) is suggested to measure the absorption of a monochromatic photon beam by bone material, usually in the heel and forearm. Similar to the DXA scan, the SXA uses only one X-ray beam energy source aimed at the bones as it passes over the individual. (Refer to Coverage Limitations section)

Trabecular bone score (TBS) software is intended as a complement to both DXA analysis and clinical examination. It allegedly assesses the structural condition or textural component of bone microarchitecture, which may provide information that is not captured from standard BMD measurement. TBS Osteo powered by TBS iNsight is an example of this technology.

Coverage Determination

Humana members may be eligible under the Plan for DXA (77080, 77081) once every 2 years when the following criteria are met:

  • Screening for osteoporosis in female:
    • 65 years of age or older; OR
    • Postmenopausal female 64 years of age or younger at increased risk of osteoporosis as determined by a formal fracture risk assessment tool (eg, FRAX tool)76
  • Humana members may be eligible under the Plan for vertebral fracture assessment from DXA (77085, 77086) once every 2 years when T-score is less than -1.0 and when any of the following criteria are met:
    • Females 70 years of age or older; OR
    • Males 80 years of age or older; OR
    • Historical height loss greater than 4 cm (greater than 1.5 inches); OR
    • Glucocorticoid therapy (eg, 5 mg or greater of prednisone or equivalent per day for greater than or equal to 3 months)

Note: The criteria for bone density measurement are not consistent with the Medicare National Coverage Policy, and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Coverage Limitations

Humana members may NOT be eligible under the Plan for DXA (77080, 77081, 77085, 77086) for any indications other than those listed above including, but may not be limited to, the following:

  • Determining body composition/whole body DXA; OR
  • Screening of males

These are considered experimental/investigational as they are not identified as widely used and generally accepted for any other proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for any BMD measurement other than DXA including, but may not be limited to, the following:

  • Bone turnover markers (BTM)/biochemical markers (82523, 83937, 84075); OR
  • Dual photon absorptiometry (DPA) (78531); OR
  • Radiofrequency echographic multi-spectrometry (REMS) (eg, EchoS) (0815T); OR
  • Microindentation of the tibia (eg, OsteoProbe) (0547T); OR
  • Pulse-echo ultrasound (eg, Bindex) (0508T); OR
  • Quantitative computed tomography, with or without finite element analysis (eg, CliniQCT/QCT Pro, VirtuOst) (77078, 0554T, 0555T, 0556T, 0557T, 0558T, 0743T); OR
  • Quantitative ultrasound densitometry (QUS) (76977); OR
  • Single-energy X-ray absorptiometry (SXA) (G0130); OR
  • Single-photon absorptiometry (SPA) (78350); OR
  • Trabecular bone score (eg, TBS Osteo powered by TBS iNsight) (77089, 77090, 77091, 77092)

These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Humana members may NOT be eligible under the Plan for AI technology intended to detect:

  • Osteoporosis/osteopenia from digital X-ray radiogrammetry via a cloud-based screening method (eg, OsteoApp.ai) (0749T, 0750T); OR
  • Vertebral fractures during abdomen/chest CT scans using automated analysis (eg, Nanox.AI) (0691T)

This is considered not medically necessary as defined in the member’s individual certificate.

Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
Page: 5 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Please refer to the member’s individual certificate for the specific definition.

Additional information about bone health and osteoporosis may be found from the following websites:

  • Bone Health & Osteoporosis Foundation
  • National Library of Medicine

Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
Page: 7 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

Provider Claims Codes

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Bone Density Measurement Effective Date: 01/01/2024
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Review Date: 05/25/2023
Policy Number: HUM-0499-022
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0547T Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia Bone-material quality testing by microindentation(s) of the tibia(s), with results reported as a score Not Covered

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Review Date: 05/25/2023
Policy Number: HUM-0499-022
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this is the 0554T current version before utilizing.

Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and Not Covered.

O555T bone mineral density, interpretation and report Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a , Y, 8 computed tomography scan; assessment of bone strength and fracture risk and bone mineral density Bone and fracture risk finite element of strength using analysis functional data, and bone-mineral density, utilizing data from a computed tomography scan; interpretation and report Not Covered.

0557T

0558T Computed tomography scan taken for the purpose of biomechanical computed tomography analysis Not Covered.

0691T Automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and report Not Covered.

0743T Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density, with concurrent vertebral fracture assessment, utilizing data from a computed tomography scan, retrieval and transmission of the scan data, measurement of bone strength and bone mineral density and classification of any vertebral fractures, with overall fracture risk assessment, interpretation and report Not Covered.

0749T Bone strength and fracture-risk assessment using digital X-ray radiogrammetry- bone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X ray data, assessment of bone strength and fracture-risk and BMD, interpretation and report Not Covered.

Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
Page: 10 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

0750T radiogrammetry- bone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X ray data, assessment of bone strength and fracture-risk and BMD, with single-view digital X-ray examination of the hand taken for the purpose of DXR-BMD Not Covered.

0815T Ultrasound-based radiofrequency echographic multi-spectrometry (REMS), bone-density study and fracture-risk assessment at various sites, hips pelvis or spine, Not Covered New Code Effective 01/01/2024.

HCPCS Code(s).

G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) Not Covered

References
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Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

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Bone Density Measurement Effective Date: 01/01/2024
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Policy Number: HUM-0499-022
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Accessed March 14, 2023.
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  1. Hays, Inc. Medical Technology Directory (ARCHIVED). Quantitative computed tomography for bone mineral density. https://evidence.hayesinc.com. Published December 8, 2010. Updated January 21, 2014. Accessed March 14, 2023.
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Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

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Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
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Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

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Bone Density Measurement Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 05/25/2023
Policy Number: HUM-0499-022
Page: 18 of 18

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