CMS Restores Osteoporosis Scan Payments

Women’s health providers must be excited about a $98 payment for dual-energy X-ray absorptiometry (DEXA) bone tests.  Starting in 2007, DEXA technology has gone through a series of reimbursement cuts.   But, as a result of the health care reform bill, providers will see a 25% increase in payment instead of another decrease that was scheduled for 2012.

CPT code 77080 (DEXA bone density, axial skeleton) the most common code used for bone scans has not seen an increase since 2006 despite rising costs in technology and labor.  Depending on volume, CMS has calculated that it costs at approximately $76 per patient.  Low-volume systems (500 patients per year) will have costs in the $90 range.  In 2010, CMS (under APC 0288) reimbursed DEXA bone tests at a rate of $70 per patient, making it a financial loss any way you look at it.

The U.S. prevention task force recommends screening for osteoporosis every two years for women ages 65 and older and younger women who are at risk.  And, when osteoporosis is diagnosed, studies have shown that drug treatment reduces the risk of fracture by 30-65%.

I asked a leading expert in the field Robert R. Recker, M.D., M.A.C.P., F.A.C.E., a professor of medicine, chief of the Section of Endocrinology, director at the Osteoporosis Research Center, and clinical professor of Periodontics at Creighton University in Omaha, Neb., about the importance of screening, and he said, “If you are going to do anything to change the outcome of osteoporosis, you first need to know early that you have the disease.  There are pharmaceutical treatments for osteoporosis, and if you can diagnose it early, you can slow the deterioration of your skeleton by a change in diet and life style.”

According to the American Association of Orthopaedic Surgeons, 44 million Americans over age 50 are at risk for fracture due to osteoporosis, and most people do not know they have osteoporosis until a fracture occurs.  This makes screening all the more important.  Although ultrasound and CT are capable of diagnosing osteoporosis, DEXA scans are currently the gold standard.  However, the declining reimbursement over the last few years has made it difficult for providers to prescribe DEXA as a routine screening technology.  Now, with the 2011 increase, both patients and providers will see the benefits of the technology.     

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.