CurrentBlue Cross Blue Shield - NebraskaPolicy M.65

MA Bone Mineral Density Scans (Preauthorization Required)

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Nebraska Policy M.65 alerts

Get alerted when Policy M.65 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines coverage and preauthorization requirements for Trabecular Bone Score (TBS) procedures derived from lumbar spine DXA images for members of Blue Cross Blue Shield - Nebraska.

Policy Summary

PayerBlue Cross Blue Shield - Nebraska

PolicyMA Bone Mineral Density Scans (Preauthorization Required)

Policy CodePolicy M.65

Change TypeNo material change

Effective DateJun 1, 2026

Last ReviewMar 1, 2027

Next Review DateFeb 3, 2027

Key ActionDo not submit claims for Trabecular Bone Score CPT codes 77089–77092; these services are considered not reasonable and necessary and are subject to denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4TBS-related procedure codes listed

Not coveredCoverage stance

06-01-2026Effective

02-04-2026Last review

Coverage Criteria — Trabecular Bone Score (TBS)

Not medically necessary - TBS

Covered when ALL of the following are met

Policy stance: Trabecular Bone Scores (CPT 77089, 77090, 77091, 77092) are considered not reasonable and necessary for any indication/condition.

This is a blanket noncoverage statement from the policy.

Uses of Trabecular Bone Score (TBS) procedures (CPT codes 77089–77092) are excluded from coverage and are considered not reasonable and necessary for any clinical indication or condition.

Trabecular Bone Scores (CPT 77089, 77090, 77091, 77092) are considered not reasonable and necessary for any indication and therefore are not covered under this policy.

Coding — TBS CPT Codes

TBS-related CPT codesCPTNot Covered

77089	TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK - Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk
77090	TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR - Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere
77091	TBS TECHNICAL CALCULATION ONLY - Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical calculation only
77092	TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP - Trabecular bone score (TBS), structural condition of the bone microarchitecture; interpretation and report on fracture-risk only by other qualified health care professional

Provider Actions — Authorization, Billing, and Denials

Prior Authorization

Preauthorization noted — TBS (77089–77092) are not reasonable and necessary

Preauthorization is referenced in the policy title; however, the policy explicitly states that Trabecular Bone Scores (CPT 77089, 77090, 77091, 77092) are considered not reasonable and necessary for any indication/condition, and providers should expect denials for these codes.

Note

No step-therapy or alternate authorization pathway for TBS

The policy contains no step-therapy or alternate authorization pathway for Trabecular Bone Score services; if providers seek guidance, follow standard preauthorization processes for bone mineral density scans per the broader policy but note TBS codes are noncovered.

Billing Rule

Coding to include on claim: report the exact TBS CPT code

Include the exact CPT code for the TBS service on the claim: 77089, 77090, 77091, or 77092 as listed in the policy.

Denial Risk

Denial risk: TBS CPT codes (77089–77092) are noncovered

Claims submitted with CPT codes 77089, 77090, 77091, or 77092 for Trabecular Bone Score services will be considered not reasonable and necessary and are subject to denial.

Codes: 77089–77092

Background

Trabecular Bone Score (TBS) is an analytic technique applied to standard lumbar spine DXA (dual-energy X-ray absorptiometry) images that analyzes gray-scale texture to estimate trabecular bone microarchitecture. TBS provides an indirect measure of bone quality and fracture risk that complements traditional bone mineral density (BMD) testing, which measures bone quantity, but this policy does not address DEXA scans coded as 77080 and 77081.

Definitions

Trabecular Bone Score (TBS) — concise definition

DefinitionA diagnostic calculation derived from lumbar spine DXA (dual-energy X-ray absorptiometry) images that analyzes gray-scale variogram texture to estimate trabecular bone microarchitecture and fracture risk (corresponds to CPT descriptions 77089–77092).

PurposeProvides an indirect measure of bone quality and fracture risk that complements bone mineral density (BMD) by assessing trabecular microarchitecture from standard lumbar spine DXA images.

Data sourceCalculated from gray-scale variogram texture of lumbar spine DXA or other imaging data used to evaluate structural condition of bone microarchitecture.

Relation to BMDIntended to complement traditional BMD tests, which measure bone quantity, by offering additional information on bone quality and fracture risk.

Associated CPT codes77089, 77090, 77091, 77092 — codes describe calculation, technical preparation/transmission, technical calculation only, and interpretation/report respectively.

Policy Summary

PayerBlue Cross Blue Shield - Nebraska

PolicyMA Bone Mineral Density Scans (Preauthorization Required)

Policy CodePolicy M.65

Change TypeNo material change

Effective DateJun 1, 2026

Last ReviewMar 1, 2027

Next Review DateFeb 3, 2027

Key ActionDo not submit claims for Trabecular Bone Score CPT codes 77089–77092; these services are considered not reasonable and necessary and are subject to denial.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

MA Bone Mineral Density Scans (Preauthorization Required)

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Nebraska Policy M.65 alerts

Get alerted when Policy M.65 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines coverage and preauthorization requirements for Trabecular Bone Score (TBS) procedures derived from lumbar spine DXA images for members of Blue Cross Blue Shield - Nebraska.

Coverage Criteria — Trabecular Bone Score (TBS)

Not medically necessary - TBS

Covered when ALL of the following are met

Policy stance: Trabecular Bone Scores (CPT 77089, 77090, 77091, 77092) are considered not reasonable and necessary for any indication/condition.

This is a blanket noncoverage statement from the policy.

Trabecular Bone Scores (CPT 77089, 77090, 77091, 77092) are considered not reasonable and necessary for any indication and therefore are not covered under this policy.

Coding — TBS CPT Codes

TBS-related CPT codesCPTNot Covered

77089	TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK - Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk
77090	TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR - Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere
77091	TBS TECHNICAL CALCULATION ONLY - Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical calculation only
77092	TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP - Trabecular bone score (TBS), structural condition of the bone microarchitecture; interpretation and report on fracture-risk only by other qualified health care professional

Provider Actions — Authorization, Billing, and Denials

Prior Authorization

Preauthorization noted — TBS (77089–77092) are not reasonable and necessary

Note

No step-therapy or alternate authorization pathway for TBS

Billing Rule

Coding to include on claim: report the exact TBS CPT code

Include the exact CPT code for the TBS service on the claim: 77089, 77090, 77091, or 77092 as listed in the policy.

Denial Risk

Denial risk: TBS CPT codes (77089–77092) are noncovered

Claims submitted with CPT codes 77089, 77090, 77091, or 77092 for Trabecular Bone Score services will be considered not reasonable and necessary and are subject to denial.

Codes: 77089–77092

Background

Definitions

Trabecular Bone Score (TBS) — concise definition

PurposeProvides an indirect measure of bone quality and fracture risk that complements bone mineral density (BMD) by assessing trabecular microarchitecture from standard lumbar spine DXA images.

Data sourceCalculated from gray-scale variogram texture of lumbar spine DXA or other imaging data used to evaluate structural condition of bone microarchitecture.

Relation to BMDIntended to complement traditional BMD tests, which measure bone quantity, by offering additional information on bone quality and fracture risk.

Associated CPT codes77089, 77090, 77091, 77092 — codes describe calculation, technical preparation/transmission, technical calculation only, and interpretation/report respectively.