Whole Body Dual X‑Ray Absorptiometry to Determine Body Composition
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This policy governs the use of whole-body DXA scans to determine body composition (fat, lean mass, bone) and applies to Capital Bluecross administered products, subject to benefit variations noted by product.
No material clinical or coverage changes in this revision.
Coverage Criteria
General coverage stance
Covered when ALL of the following are met
Insufficient evidence that DXA body composition measurements improve net health outcomes or have been used to guide patient management.
Whole-body dual-energy x-ray absorptiometry (DXA) studies to determine body composition are considered investigational and are not covered under this policy.
DXA body composition studies reported using procedure code 76499 are considered investigational and are not covered.
The evidence is insufficient to show that whole-body DXA body composition testing improves health outcomes. Available studies are primarily research-focused, often using DXA as a reference standard or measurement tool, and importantly, no studies were identified in which DXA body composition measurements were actively used to guide patient management. Consequently, the literature does not demonstrate that DXA body composition results lead to changes in care that improve net health outcomes.
Potential Clinical Applications
Potential clinical applications
These are potential clinical settings described in the background and literature but do not constitute covered indications because DXA body composition is designated investigational by this policy.
Coding
| KGI | FDA product code for DXA body composition software |
| 76499 | Unlisted procedure, radiology (listed as investigational when used to report a DXA body composition study) |
Provider Actions & Billing Guidance
Preauthorization / benefit check
Coverage and any preauthorization requirement for DXA body composition studies depend on the member's specific health benefit plan; providers should consult the member's benefit documents or contact Capital Blue Cross to determine if preauthorization is required.
- The existence of this medical policy does not mean the service is a covered benefit under the member's plan.
- Benefit determinations must be based on the applicable health benefit plan language.
Investigational procedure code (76499)
Procedure code 76499 is identified in this policy as investigational when used to report a DXA body composition study and is not covered; prior authorization would not make investigational services covered.
- Procedure Codes 76499 are listed as investigational and not covered for DXA body composition.
Investigational designation — denial risk
Requests for whole‑body DXA body composition studies are considered investigational and may be denied as not medically necessary.
- DXA body composition studies are considered investigational per policy statement.
Expect possible denial for whole‑body DXA body composition
Coverage for DXA body composition (whole‑body) is investigational; providers should expect requests to be reviewed and potentially denied as not medically necessary.
- There is insufficient evidence that DXA body composition testing improves health outcomes.
Benefit verification required
Benefit determinations must be based on the member's applicable health benefit plan language; this medical policy does not guarantee coverage and plan terms govern coverage, exclusions, limits, and preauthorization requirements.
- Members and providers should consult the member's health benefit plan or contact Capital Blue Cross for benefit information.
Coding and documentation note
The coding information provided may not be all‑inclusive; identification of a code in the policy does not denote coverage—coverage is determined by the member's benefit information.
- Codes are subject to change and not all covered services are eligible for separate reimbursement.
Whole‑body DXA body composition — investigational (not covered)
Whole‑body DXA body composition studies are considered investigational and therefore not covered; providers should not expect coverage for requests for these studies.
- The policy states DXA body composition studies are investigational with insufficient evidence of benefit.
Investigational coding — denial risk for CPT 76499
Submitting claims or billing Capital Blue Cross using procedure code 76499 to report a DXA body composition study is considered investigational and may be denied; this code is listed as investigational and not covered.
- Use of 76499 for DXA body composition is identified as investigational and not covered.
- Identification of the code in the policy does not imply coverage; verify member benefits.
DXA body composition — benefit and preauthorization verification
Coverage and any preauthorization requirement for DXA body composition studies are determined by the member's specific benefit plan; providers should verify benefits and preauthorization requirements with Capital Blue Cross before scheduling.
- Prior authorization decisions are governed by the member's health benefit plan.
- Contact Capital Blue Cross or review the member's plan documents for benefit details.
Not Covered
Whole-body DXA body composition studies (DXA for body composition) are considered investigational and are not covered under this policy.
Reporting a DXA body composition study with procedure code 76499 is considered investigational and is not covered.
Background
Dual-energy x-ray absorptiometry (DXA) uses low-dose x-rays at two energy levels to estimate bone mineral content and soft-tissue composition. DXA can provide regional and whole-body measures of fat, lean mass, and bone. Although body composition software for some DXA systems has received regulatory clearance, the primary evidence base is research-oriented and does not establish that DXA-derived body composition measurements change clinical management to improve outcomes.
Definitions
References & Revision History
References and guidance sources listed and updated (numbered references up to 40, including BCBS Association policy ref Oct 2024).
Policy MP 5.037 (Whole Body DXA to Determine Body Composition) became effective; references and guidance maintained as listed.
Capital Bluecross medical policy MP 5.037 became effective (Whole Body Dual X‑Ray Absorptiometry to Determine Body Composition).
Policy last reviewed on 2024-10-17 as noted in policy metadata prior to the 2025 effective date.
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