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News for Priority Health Provider Network
April/May 2011

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Scheduling bone mineral density tests

We’re calling our female members who’ve suffered a fracture within the past year and haven’t had a bone density test or filled a related bone-strengthening prescription within six months of the fracture. We want to encourage them to schedule a bone mineral density test. Patients who call your office to schedule the test may be concerned about paying for an office visit. If you don’t need to see the patient, you can refer them to testing without an office visit. This will save the member money because Medicare covers one test every two years.

You can use the following codes to bill the test and/or therapies to Priority Health.

Table OMW-B:
Codes to Identify Bone Mineral Density Test

CPT HCPCS ICD-9-CM Diagnosis ICD-9-CM
Procedure
76977, 77078-77083, 78350, 78351 G0130 V82.81 88.98

Table OMW-C:
FDA-Approved Osteoporosis Therapies

Description Prescription J Codes
Biphosphonates
  • alendronate
  • alendronate-cholecalciferol
  • calcium carbonate-risedronate
  • ibandronate
  • risedronate
  • zoledronic acid
J1740,
J3488,
J3487
Estrogens
  • conjugated estrogens
  • conjugated estrogens synthetic
  • esterified estrogens
  • estradiol
  • estradiol acetate
  • estradiol cypionate
  • estradiol valerate
  • estropipate
J1000
Miscellaneous hormones
  • calcitonin
  • raloxifene
  • teriparatide
J0630,
J3110
Sex hormone combinations
  • conjugated estrogens—
    medroxy-progesterone
  • estradiol-levonorgestrel
  • estradiol-norethindrone
  • estradiol-norgestimate
  • ethinyl estradiolnorethindrone
 

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