Bone mass measurement (BMM) studies are _radiologic, radioisotopic or other
procedures that meet all of the  
following conditions:_  
  

  * quantify bone mineral density, M _detect bone loss or determine bone quality_ ;
  * _are performed with either a bone densitometer (other than single-photon or dual-photon  
absorptiometry) or a bone sonometer system that has been cleared for marketing
for BMM by the Food  
and Drug Administration (FDA) under 21 CFR part 807, or approved for marketing
under 21 CFR part  
814._

  * _include a physician's interpretation of the results._

  
The following procedures are used to measure bone mineral density:

  * dual energy x-ray absorptiometry (DXA)
  * radiographic absorptiometry (RA);
  * bone sonometry (ultrasound);
  * single energy x-ray absorptiometry; (SEXA),
  * quantitative computed tomography (QCT).

  
_**Indications:**  
  
Medicare will cover a bone mass measurement test when it meets all of the
following criteria:_

_  
1\. It is performed with one of the covered tests listed above.  
  
2\. It is performed on a qualified individual for the purpose of identifying
bone mass, detecting bone loss or  
determining bone quality. The term "qualified individual" means an individual
who meets the medical  
indications for at least one of the five categories listed below:_

_  
__ A woman who has been determined by the physician or a qualified
nonphysician practitioner  
treating her to be estrogen-deficient and at clinical risk for osteoporosis,
based on her medical  
history and other findings;  
 An individual with vertebral abnormalities as demonstrated by an x-ray to be
indicative of  
osteoporosis, osteopenia (low bone mass), or vertebral fracture;  
 An individual receiving (or expecting to receive) glucocorticoid (steroid)
therapy equivalent to 5  
mg of prednisone, or greater, per day, for more than three (3) months;  
 An individual with primary hyperparathyroidism;  
 An individual being monitored to assess the response to or efficacy of an
FDA-approved  
osteoporosis drug therapy._

_3\. It is furnished by a qualified supplier or provider of such services
under at least the general level of  
supervision of a physician as defined in 42 CFR 410.32(b).  
  
4\. The test is ordered by the individual's physician or qualified non-
physician practitioner, who is treating  
the beneficiary following an evaluation of the need for the measurement,
including a determination as  
to the medically appropriate measurement to be used for the individual, and
who uses the results in the  
management of the patient.  
  
5\. The test is reasonable and necessary for diagnosing, treating, or
monitoring of a "qualified individual"  
as defined above in #2. Monitoring is defined as subsequent testing in
patients on FDA-approved drug  
therapy.  
  
6\. Medicare may cover a bone mass measurement for a beneficiary once every 2
years (if at least 23  
months have passed since the month the last bone mass measurement was
performed).  
  
7\. For conditions specified, Medicare will cover a bone mass measurement for
a qualified beneficiary  
more frequently than every two years, if medically necessary for the diagnosis
or treatment of the  
patient and if related to the condition listed. In these instances payment may
be made for tests  
performed after eleven months have elapsed since the previous bone mass
measurement test.  
Examples include, but are not limited to, the following medical circumstance:  
  
_

_ Monitoring beneficiaries on long-term glucocorticoid ( 5 mg/day) therapy of
more than 3  
months (patients must be on glucocorticoids for greater than three months
duration, but BMM  
monitoring is at yearly intervals)._

_  
 Confirming baseline BMMs to permit monitoring of beneficiaries in the
future.  
  
 _In addition, bone mass measurement for the following may be reimbursed more
frequently than  
every two years:_  
  
 Follow up bone mineral density testing to assess FDA-approved osteoporosis
drug therapy until  
a response to such therapy has been documented over time._

_8\. A confirmatory baseline BMM is only covered when it is performed with a
dual-energy x-ray  
absorptiometry system (axial skeleton) and the initial BMM was not performed
by a dual-energy x-ray  
absorptiometry system (axial skeleton).  
A confirmatory baseline BMM is not covered if the initial BMM was performed by
a dual-energy x-ray  
absorptiometry system (axial skeleton).  
  
9\. For an individual being monitored to assess the response to, or efficacy
of, an FDA-approved  
osteoporosis drug therapy, the test is only covered if it is performed with a
dual-energy x-ray  
absorptiometry system (axial skeleton).  
  
10\. The test must include a physician's interpretation of the results.  
  
11\. Since not every woman who has been prescribed estrogen replacement
therapy (ERT) may be receiving  
an "adequate" dose of the therapy, the fact that a woman is receiving ERT
should not preclude her  
treating physician/other qualified nonphysician practitioner from ordering a
bone mass measurement  
test for her. If a bone mass measurement test is ordered for a woman following
a careful evaluation of  
her medical need, it is expected that the ordering/treating
physician/qualified non-physician practitioner  
will document, why he or she believes that the woman is estrogen deficient and
at clinical risk for  
osteoporosis.  
  
_