CurrentUnitedHealthcarePolicy 2025R8O04A

Bone turnover marker testing reimbursement for osteoporosis

Defines UnitedHealthcare reimbursement methodology and frequency limits for specified bone turnover marker test procedure codes billed on CMS-1500/UB-04 forms for Commercial and Individual Exchange plans.

Policy Summary

PayerUnitedHealthcare

PolicyBone turnover marker testing reimbursement for osteoporosis

Policy CodePolicy 2025R8O04A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionBill the listed bone turnover marker procedure codes for osteoporosis no more than once every three months per code for each member; limitation applies regardless of billing or rendering provider.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

once/3mofrequency limit

83500,83505,83937,84080procedure codes

Commercial & Exchangeproduct lines

CMS-1500 & UB-04claim forms

Reimbursement Criteria

Policy Summary

PayerUnitedHealthcare

PolicyBone turnover marker testing reimbursement for osteoporosis

Policy CodePolicy 2025R8O04A

Change TypeNo material change

Effective Date

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.

Reimbursement is considered for the listed bone turnover marker procedure codes when billed for osteoporosis.

ALL of the following

Each listed procedure code may be reimbursed once every three months when billed for osteoporosis.
The frequency limitation applies to each procedure code individually (limits do not aggregate across codes).
Applies per procedure code.
The once-every-three-months limitation is applicable regardless of billing and/or rendering provider or facility for the individual member.

Codes addressed

CPT 83500
CPT 83505
CPT 83937
CPT 84080

The frequency limitation in this policy applies only when the listed codes are billed for osteoporosis; when billed for other conditions the limitation does not apply.

Procedure Codes and Frequency

Bone turnover marker testsCPTCovered

83500	Bone turnover marker test (listed in policy)
83505	Bone turnover marker test (listed in policy)
83937	Bone turnover marker test (listed in policy)
84080	Bone turnover marker test (listed in policy)

Frequency limit — bone turnover marker testing

LimitOnce every 3 months per procedure code when billed for osteoporosis

ScopeApplies to each listed bone turnover marker procedure code individually (per member)

Provider applicabilityLimitation applies regardless of billing or rendering provider or facility for the individual member

Condition restrictionFrequency limitation applies only when the listed codes are billed for osteoporosis

Billing and Provider Guidance

Billing Rule

Frequency and billing guidance for bone turnover marker testing

UnitedHealthcare will consider reimbursement for the listed bone turnover marker procedure codes when billed for osteoporosis, subject to a frequency limit of once every three months per procedure code. The limitation applies at the member level regardless of billing or rendering provider or facility; codes billed for other conditions are not subject to this osteoporosis-specific limit.

Frequency limit: once every three months per procedure code when billed for osteoporosis.
Limit applies regardless of billing or rendering provider (individual provider or facility) for the individual member and date of service.
Frequency limitation only applies when codes are billed for osteoporosis; codes billed for other conditions are not subject to this limit.

OpenPayer

Bone turnover marker testing reimbursement for osteoporosis

Reimbursement Criteria

Procedure Codes and Frequency

Billing and Provider Guidance

Terminology and Limit Notes