Summary & Overview
CPT 78350: Single-Photon Bone Mineral Density Measurement
CPT code 78350 represents single-energy photon bone densitometry, a diagnostic imaging procedure that measures bone mineral density to evaluate conditions such as osteoporosis. Nationally, bone density testing informs screening, diagnosis, and management of metabolic bone disease and contributes to population-level fracture risk assessment and preventive care strategies. This code includes both the technical and professional components of the service.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical purpose and typical service settings, payer coverage context, and the elements that affect billing of this combined professional/technical procedure. The publication covers reimbursement benchmarks and common billing considerations tied to service setting and code components, highlights relevant policy updates affecting coverage and documentation, and explains where CPT code 78350 fits among bone densitometry services clinically and administratively.
This summary is intended for national audiences including coders, billing managers, clinical leaders, and policy analysts seeking a focused briefing on the code’s clinical role, billing scope, and payer coverage context.
Billing Code Overview
CPT code 78350 describes a diagnostic imaging procedure that uses a single-energy photon beam to measure bone mineral density (BMD). The test quantifies the mineral content of bone per unit area to help identify conditions such as osteoporosis by assessing bone strength and fracture risk.
Service type: Diagnostic bone densitometry (single-photon absorptiometry), whole body or segmental as described.
Typical site of service: Outpatient imaging centers, hospital outpatient departments, or ambulatory diagnostic facilities.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old postmenopausal woman presents to the outpatient radiology clinic for evaluation of fracture risk after a recent low-energy wrist fracture. The ordering primary care provider requests assessment of bone mineral density (BMD) to screen for osteoporosis and to guide treatment decisions. The patient checks in at the imaging front desk, completes intake and metal-removal instructions, and is escorted to the DEXA scanning room. A certified radiologic technologist confirms patient identity, reviews contraindications (e.g., recent contrast studies or pregnancy), and performs positioning for a single-energy photon absorptiometry scan targeting the lumbar spine and proximal femur as clinically indicated. The provider documents clinical indication, obtains informed consent as required, and interprets the study. The report includes measured BMD values, T-scores and Z-scores, comparison to prior studies if available, and an impression indicating presence or absence of osteopenia or osteoporosis. Billing is submitted for 78350 representing the combined technical and professional components for a single-energy photon bone density measurement, with the appropriate ICD-10 diagnosis code(s) linked for medical necessity and reimbursement.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the physician interpretation/report is billed separately from technical component |