Summary & Overview
CPT 77091: Trabecular Bone Score Fracture Risk Calculation
CPT code 77091 denotes the technical calculation of a patient’s fracture risk using trabecular bone score, an imaging-derived measure that augments bone mineral density assessment. Nationally, this code matters because it supports clinically relevant fracture-risk stratification that can influence management decisions for patients at risk of osteoporosis-related fractures and aligns imaging analytics with value-based care initiatives.
Key payers included in the coverage landscape are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical service setting, and common billing context. The publication summarizes payer coverage patterns, reimbursement benchmarks, and policy updates that affect billing and documentation for this diagnostic calculation. It also provides clinical context on how trabecular bone score complements bone mineral density testing and what providers and billing staff should record when using CPT code 77091.
This analysis is intended for a national audience and offers practical reference material on coding classification, payer landscape, and operational considerations related to CPT code 77091. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 77091 describes a technical calculation of a patient’s fracture risk based on trabecular bone score. The service is a diagnostic risk-calculation procedure that uses image-derived trabecular bone texture to estimate fracture risk.
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Service type: Diagnostic risk calculation
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Typical site of service: Radiology or imaging service setting, often performed in conjunction with bone densitometry or other imaging studies
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old postmenopausal woman with a history of osteopenia is referred by her primary care physician for bone health assessment. She undergoes a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density; the imaging facility derives a trabecular bone score (TBS) from lumbar spine DXA raw data. The provider performs the technical calculation of fracture risk based on the TBS result and integrates that value with femoral neck T-score and clinical risk factors to produce a quantified fracture risk estimate used by the referring clinician for management decisions. Typical workflow: the DXA technologist acquires images; the image set is transferred to software that computes TBS; a qualified provider (radiologist, endocrinologist, or bone health specialist) reviews the TBS output, performs the technical computation for fracture risk (e.g., adjustment of FRAX or other risk models using TBS), documents the calculated risk in the report, and delivers the result to the referring clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component (interpretation and calculation) is billed separate from the technical component of the DXA/TBS acquisition. |
TC |