CurrentUnitedHealthcarePolicy 2025R8204A

Bone marker testing frequency limitation for osteoporosis

This policy governs reimbursement frequency limits for bone marker testing billed to UnitedHealthcare Medicare Advantage on CMS 1500/UB04; it affects providers billing for osteoporosis-related bone marker tests for UnitedHealthcare Medicare Advantage members.

Policy Summary

PayerUnitedHealthcare

PolicyBone marker testing frequency limitation for osteoporosis

Policy CodePolicy 2025R8204A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review Date

Key ActionLimit reimbursement to one bone marker test per procedure code every 90 consecutive days (once every 3 months), counted across billing and rendering providers for the same member and date of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Once every 3 monthsallowed frequency

Per procedure codescope

Yesapplies across providers

Reimbursement Frequency Criteria

Reimbursement frequency criteria

Frequency and applicability rules for reimbursement of bone marker testing billed for osteoporosis:

Allow one bone marker test per procedure code every 90 consecutive days (Once every 3 Months).90 consecutive calendar days from initial date of service

Limitation applies per procedure code and is counted across any billing or rendering provider for the same member and date of service.

The frequency limitation in this policy applies only when bone marker testing procedure codes are billed for osteoporosis; billing for other conditions may be considered separately.

Codes and Interval Definitions

Bone marker testingmixed

No codes listed

Policy Summary

PayerUnitedHealthcare

PolicyBone marker testing frequency limitation for osteoporosis

Policy CodePolicy 2025R8204A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Billing and Applicability Notices

Billing Rule

Frequency Limitation Applicability

The once-every-three-months frequency limitation applies to each member regardless of which provider bills or renders the service. This means the limit is enforced across all individual providers and facilities for the same date of service for that member.

Applies across all billing and rendering providers (individual providers and facilities)
Counts per member for the same date of service

Billing Rule

Per-code Frequency Rule

Frequency limits are applied on a per-procedure-code basis. Each bone marker testing CPT/HCPCS code is tracked independently for the applicable frequency restriction.

Each procedure code is subject to its own frequency count
Codes do not aggregate toward a single combined limit

Billing Rule

Condition-specific Application

The policy's frequency limitation applies only when the bone marker testing procedure codes are billed for osteoporosis. Bone marker testing billed for other conditions is not subject to this osteoporosis-specific frequency restriction.

Frequency limit applies only when diagnosis or indication is osteoporosis
Testing billed for other conditions may be considered separately