Computed tomography–based bone mineral density (BMD) studies and ultrasound bone density measurement are not considered medically necessary for Commercial Products because the evidence is insufficient to determine effects on health outcomes. Dual‑energy X‑ray absorptiometry (DXA) of central sites (hip and spine) remains the preferred modality for diagnosis and monitoring; peripheral DXA may be covered in select situations but CT and ultrasound modalities lack evidence of improving net health outcomes.

The following procedure codes are designated not medically necessary for Commercial Products: 76977 (ultrasound bone density measurement and interpretation), 77078 (CT bone mineral density study), G0130 (single‑energy X‑ray absorptiometry), and codes for CT finite element analysis (0554T–0558T). Claims using these codes may be denied due to insufficient evidence that these modalities improve health outcomes compared with central DXA.

Single‑ and dual‑photon absorptiometry (SPA/DPA), ultrasound densitometry (for Commercial Products), and computed tomography–based BMD studies (including QCT and CT finite element analyses) are considered not medically necessary or not covered when used in place of central DXA because current evidence does not demonstrate an improvement in clinically meaningful outcomes. Central DXA of the hip and spine is preferred for initial diagnosis and repeat assessment of osteoporosis.

For Commercial Products, the use of the specific codes 76977, 77078, G0130, and 0554T–0558T is explicitly listed as not medically necessary. Providers should submit claims with covered DXA CPT codes when appropriate and be aware that claims with these listed codes may be denied.

Bone mineral density (BMD) testing is used to identify individuals with osteoporosis and to monitor response to therapy with the goal of reducing fracture risk. Dual‑energy X‑ray absorptiometry (DXA) of central sites (hip and spine) is the most predictive modality for fragility fractures and is the preferred method for initial diagnosis and repeat assessments. Other modalities such as peripheral DXA, quantitative computed tomography, and ultrasound densitometry exist but have less evidence that they identify patients who will benefit from pharmacologic treatment or that repeat measurements with these technologies improve clinical outcomes.