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Medical Policy Update: Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry

Effective April 29, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after April 29, 2019 to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT® code 76977 or HCPCS code G0130.

    Following our review of medical record information, the services represented by the codes above may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

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 April 29, 2019.

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

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members are processed based on our policy guidelines.

Published on: March 27, 2019, 12:22 p.m. ET
Last updated on: March 27, 2019, 13:36 p.m. ET