Medical Policy Revision: Bone Mineral Density Studies and Vertebral Fracture Assessment with Densitometry

Effective July 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims that include codes for bone mineral density studies.

Based on the guidelines of our revised medical policy, Bone Mineral Density Studies and Vertebral Fracture Assessment with Densitometry:

• CPT® codes 77086, 78350 or 78351 submitted on claims for services provided on and after July 22, 2015 will be denied as investigational services regardless of the submitted diagnosis.
• CPT code 77081 or HCPCS code G0130 submitted on claims for services provided on and after July 22, 2015 will be denied as not medically necessary regardless of the submitted diagnosis.

Review this revised policy in our online Medical Policy Manual.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after July 22, 2015.

CPT® is a registered mark of the American Medical Association.