CPT 0691T: Automated CT Analysis for Vertebral Fracture Detection and Bone Density - OpenPayer

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Summary & Overview

CPT 0691T: Automated CT Analysis for Vertebral Fracture Detection and Bone Density

CPT code 0691T covers an automated analysis of an existing CT dataset to check for vertebral fractures and may include bone density assessment. The code bundles data preparation, automated image processing, interpretation, and a clinical report. As imaging analytics and AI-driven tools become more integrated into clinical workflows, this code reflects a growing national emphasis on opportunistic fracture screening and fracture risk assessment using already-acquired CT studies. Its use can support earlier identification of osteoporotic fractures and secondary prevention efforts.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for opportunistic vertebral fracture detection, the typical service setting (imaging centers and hospital outpatient radiology), and the components of the billed service. The publication presents benchmarks and coverage patterns where available, summarizes policy and coding guidance relevant to automated image analysis services, and outlines operational considerations for documenting components included in the code (data preparation, analysis, interpretation, and report). Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0691TCPTCTvertebral fracturebone densityradiologyautomated image analysisimaging analytics

Billing Code Overview

CPT code 0691T describes an automated analysis of an existing computed tomography (CT) dataset to detect vertebral fractures and may include an assessment of bone density. The service includes data preparation, automated image analysis, interpretation, and generation of a clinical report.

Service type: Automated image analysis and interpretation of CT data for vertebral fracture detection and optional bone density assessment
Typical site of service: Imaging centers or hospital outpatient radiology departments where CT datasets are available for secondary analysis

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 72-year-old woman with a history of osteoporosis and recent minor height loss is seen by her primary care physician after she reports mid-thoracic back pain following a household fall. A prior chest and abdominal CT performed two weeks earlier for unrelated reasons is available in the radiology PACS. The clinician requests an automated vertebral fracture assessment using 0691T to screen the existing CT dataset for vertebral compression fractures and to assess opportunistic bone density.

Workflow: The radiology practice locates the existing CT series and transmits the DICOM dataset to an FDA-cleared automated analysis software. The service includes data preparation (segmentation and quality checks), automated algorithmic detection of vertebral body deformities, optional quantitative bone density metrics, and radiologist review of the generated images and structured results. The radiologist documents interpretation and final report; when applicable, the professional component modifier 26 is appended. The technical component (software processing and image storage) may be billed with modifier TC when separated. Typical sites of service include outpatient imaging centers, hospital radiology departments, and teleradiology services supporting remote reads. Common clinical indications include suspected vertebral compression fracture, osteoporosis screening, trauma screening, or incidental evaluation during CT performed for other indications.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
2085R0200X	Radiology	Diagnostic radiologists interpret automated vertebral fracture analyses and finalize reports.
207RC0000X	Diagnostic Radiology - Neuroradiology	Neuroradiologists or musculoskeletal radiologists may review thoracic or lumbar spine findings.
2084P0800X	Orthopedic Surgery	Orthopedists evaluate results for surgical planning when vertebral fractures or instability are identified.
207L00000X	Internal Medicine	Primary care physicians and internists initiate screening and coordinate osteoporosis management based on findings.
364S00000X	Emergency Medicine	Emergency physicians may request rapid automated analysis for trauma patients with available CT scans.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M80.08XA`	Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture	Direct indication for vertebral fracture assessment; automated analysis can detect compression fractures associated with osteoporotic disease.
`M81.0`	Age-related osteoporosis without current pathological fracture	Automated bone density assessment from CT can identify low bone mass prompting medical management.
`S32.010A`	Wedge compression fracture of first lumbar vertebra, initial encounter	Trauma-related vertebral fractures apparent on CT can be detected by the automated algorithm.
`S22.009A`	Fracture of unspecified thoracic vertebra, initial encounter	Thoracic spine fractures are a primary target of `0691T` analysis when present on existing CT datasets.
`M48.50`	Collapsed vertebra, unspecified region	Vertebral collapse or compression deformity findings are clinically relevant and captured by the automated assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71250`	CT chest without contrast material	May generate an existing thoracic CT dataset that is eligible for opportunistic automated vertebral fracture analysis with `0691T`.
`74177`	CT abdomen and pelvis with contrast, including image post-processing when performed	Abdominal/pelvic CTs that include portions of the thoracolumbar spine can be analyzed by `0691T` for incidental vertebral fractures and bone density assessment.
`72157`	MR lumbosacral spine without contrast	MR spine is an alternative modality for dedicated evaluation; MR may be performed after `0691T` flags a suspected fracture requiring confirmatory imaging.
`77080`	Dual-energy X-ray absorptiometry (DXA) bone density study, axial (central)	DXA is the standard quantitative bone density test often ordered after `0691T` reports low bone density or suggests osteoporosis.
`76140`	CT guidance for biopsy, percutaneous, needle placement	If `0691T` identifies lesions or fractures prompting biopsy or stabilization, CT-guided procedures may follow and be separately coded.

`26`	Professional component	Use when billing only the radiologist interpretation and report for `0691T` separate from technical processing.
`TC`	Technical component	Use when billing only the software processing, image reconstruction, and storage for `0691T`.
`52`	Reduced services	Use when the automated analysis is partially completed or yields limited evaluation due to incomplete coverage of the spine in the CT dataset.
`53`	Discontinued procedure	Use when the service is started but stopped for patient safety or dataset insufficiency before meaningful analysis.
`78`	Return to operating/procedure room for related procedure by same physician	Rare, but applicable if analysis prompts an immediate image-guided intervention during the same surgical encounter.
`22`	Increased procedural services	Use when reporting requires significantly more work (extensive additional image preparation or complex manual correction of automated segmentations) supporting additional documentation.
`62`	Two surgeons/dual surgeon involvement	Use when two surgeons or proceduralists share responsibility for an interventional procedure prompted by the analysis (uncommon for pure interpretation services).
`QK`	Medical direction of two or more qualified individuals	Use if the radiologist medically directs multiple allied health staff performing parts of the service per credentialing rules.
`QX`	CRNA service with qualified anesthetist absent	Included here for completeness in mixed-procedure encounters when anesthesia services are reported alongside interventions triggered by the analysis.
`QY`	Qualified nonphysician anesthetist	Similar contextual use when nonphysician anesthesia services are involved in subsequent procedures.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services in facility setting	Use when an advanced practice clinician performs parts of the processing or documentation under appropriate supervision.
`CS`	(Data not provided)	Data not available in the input.
`FY`	Data not provided	Data not available in the input.