CurrentColorado Rocky Mountain Health PlansPolicy 2025R8204A

Bone turnover marker testing reimbursement for osteoporosis

Defines UnitedHealthcare Medicare Advantage reimbursement methodology and frequency limits for bone turnover marker testing billed on UB04 (CMS 1450) or CMS 1500 forms for members, and applies to network providers under UnitedHealthcare Medicare Advantage plans.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyBone turnover marker testing reimbursement for osteoporosis

Policy CodePolicy 2025R8204A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReimburse each listed bone turnover marker procedure code once every 3 months (90 consecutive calendar days) when billed for osteoporosis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

every 3 monthsmaximum reimbursable frequency

3 procedure codesprocedure codes listed

CMS 1500 & UB04claim form applicability

Medicare Advantageplan applicability

Reimbursement Criteria

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Reimbursement criteria for bone turnover marker testing

UnitedHealthcare will consider reimbursement for the listed bone turnover marker procedure codes subject to frequency limitations when billed for osteoporosis.

Each of the following procedure codes is eligible for reimbursement once every three months (90 consecutive calendar days) when billed for osteoporosis: 83500, 83505, 83937, 84080.

Frequency limitation applies per procedure code — the once-every-three-months limit is applied to each listed procedure code individually.

The once-every-three-months frequency limitation is applicable regardless of billing and/or rendering provider (applies to any individual provider or any facility) for each individual member for the same date of service.

UnitedHealthcare will consider reimbursement of the listed procedure codes when billed with other conditions; the frequency limitation in this policy applies only when the codes are billed for osteoporosis.

Procedure Codes and Frequency Limits

Bone turnover marker procedure codesCPTCovered

83500	Assay of bone turnover marker (listed as primary code in policy)
83505	Bone turnover marker test (policy lists as paired with 83500)
83937	Bone marker assay (listed in policy mapping)
84080	Bone marker assay (listed in policy mapping)

Frequency limit

Frequency limitOne reimbursable test per procedure code every 3 months (90 consecutive calendar days) when billed for osteoporosis.

Scope per codeLimit applies to each listed procedure code individually (83500, 83505, 83937, 84080).

Applies when billed forOsteoporosis — frequency limit applies specifically when services are billed for osteoporosis.

Claim formsApplies to services billed on UB04 (CMS 1450) or CMS 1500 forms as noted in policy scope.

Billing and Authorization Notes

Prior Authorization

Prior authorization note

This policy does not include prior authorization requirements. Providers should refer to the enrollee's benefit coverage documents or contact customer service (number on the member ID card) for information about coverage and any prior authorization requirements that may apply.