I 

111TH CONGRESS 

1ST SESSION H. R. 1894 

To amend title XVIII of the Social Security Act to improve access to, 

and increase utilization of, bone mass measurement benefits under the 

Medicare part B program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 2, 2009 

Ms. BERKLEY (for herself, Mr. BURGESS, Mr. PAYNE, Mr. GRIJALVA, Mr. 

MCGOVERN, Mrs. CAPPS, Ms. SCHAKOWSKY, Mr. LEWIS of Georgia, Mr. 

OLVER, Ms. BALDWIN, Mr. SESTAK, Mr. HINOJOSA, Mr. CULBERSON, 

Mr. BOSWELL, Mr. GENE GREEN of Texas, Ms. KILPATRICK of Michigan, Mr. PAUL, Mrs. LOWEY, Mr. COURTNEY, Ms. SUTTON, Ms. 

WASSERMAN SCHULTZ, Mrs. CHRISTENSEN, Ms. JACKSON-LEE of Texas, 

Ms. SCHWARTZ, Mr. SESSIONS, Mr. THOMPSON of California, Ms. KILROY, Ms. HIRONO, Mr. MCDERMOTT, Ms. CASTOR of Florida, Mr. 

FALEOMAVAEGA, Mrs. DAVIS of California, Mr. ENGEL, Mr. WEXLER, 

Mr. TANNER, Mr. FARR, Mr. SHERMAN, Ms. WATSON, Ms. TITUS, Ms. 

MOORE of Wisconsin, Ms. LINDA T. SA ́NCHEZ of California, Ms. 

KOSMAS, Mr. KENNEDY, Mr. GEORGE MILLER of California, Ms. SPEIER, 

Ms. TSONGAS, Ms. DEGETTE, Mrs. NAPOLITANO, Mr. CARNAHAN, Ms. 

ROYBAL-ALLARD, Mr. KAGEN, Ms. HARMAN, Mr. SERRANO, Ms. MARKEY of Colorado, Mr. SCOTT of Virginia, Ms. SHEA-PORTER, Mrs. 

MALONEY, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. MEEKS of New 

York, Ms. WOOLSEY, Ms. LEE of California, Ms. CLARKE, Ms. CORRINE

BROWN of Florida, Ms. EDWARDS of Maryland, and Mr. PIERLUISI) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to improve 


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access to, and increase utilization of, bone mass measurement benefits under the Medicare part B program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Fracture 

5 Prevention and Osteoporosis Testing Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Since 1997, Congress has recognized the 

9 importance of osteoporosis prevention by standard10 izing reimbursement under the Medicare program 

11 for bone mass measurement. 

12 (2) One decade later, osteoporosis remains 

13 underdiagnosed and untreated despite numerous 

14 Federal initiatives, including recommendations of the 

15 United States Preventive Services Task Force, the 

16 2004 United States Surgeon General’s Report on 

17 Bone Health and Osteoporosis, and inclusion of bone 

18 mass measurement in the Welcome to Medicare 

19 exam. 

20 (3) Even though osteoporosis is a highly man21 ageable disease, many patients lack access to early 

22 diagnosis that can prevent debilitating fractures, 

23 morbidity, and loss of mobility. 


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1 (4) Although Caucasians are most likely to sus2 tain osteoporosis fractures, the cost of fractures 

3 among the nonwhite population is projected to in4 crease by as much as 180 percent over the next 20 

5 years. 

6 (5) Black women are more likely than White 

7 women to die following a hip fracture. 

8 (6) Osteoporosis is a critical women’s health 

9 issue. Women account for 71 percent of fractures 

10 and 75 percent of osteoporosis-associated costs. 

11 (7) The World Health Organization, the Cen12 ters for Medicare & Medicaid Services, and other 

13 medical experts concur that the most widely accept14 ed method of measuring bone mass to predict frac15 ture risk is dual-energy x-ray absorptiometry (in this 

16 Act referred to as ‘‘DXA’’). Vertebral fracture as17 sessment (in this Act referred to as ‘‘VFA’’) is an18 other test used to identify patients at high risk for 

19 future fracture. 

20 (8) DXA is a cost-effective preventive test with 

21 proven results in real world settings. DXA testing 

22 increases the number of people diagnosed with 

23 osteoporosis and treated so that hip fractures and 

24 related costs are dramatically reduced. 


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1 (9) Unlike other imaging procedures DXA re2 mains severely underutilized, with only one in four 

3 women eligible for the Medicare program using the 

4 benefit that provides for bone mass measurement 

5 every two years. 

6 (10) Underutilization of bone mass measure7 ment will strain the Medicare budget because— 

8 (A) 55 percent of the people age 50 and 

9 older in 2002 had osteoporosis or low bone 

10 mass; 

11 (B) more than 61,000,000 people in the 

12 United States are projected to have osteoporosis 

13 or low bone mass in 2020, as compared to 

14 43,000,000 in 2002; 

15 (C) osteoporosis fractures are projected to 

16 increase by almost 50 percent over the next 2 

17 decades with at least 3,000,000 fractures ex18 pected to occur annually by 2025; 

19 (D) the population aged 65 and older rep20 resents 89 percent of fracture costs; and 

21 (E) the economic burden of osteoporosis 

22 fractures are projected to increase by 50 per23 cent over the next 2 decades, reaching 

24 $25,300,000,000 in 2025. 


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1 (11) Underutilization of bone mass measure2 ment will also strain the Medicaid budget, which 

3 funds treatment for osteoporosis in low-income 

4 Americans. 

5 (12) Reimbursement under the Medicare pro6 gram for DXA provided in physician offices and 

7 other non-hospital settings was reduced by 50 per8 cent and is scheduled to be reduced by a total of 62 

9 percent by 2010. This drop represents one of the 

10 largest reimbursement reductions in the history of 

11 the Medicare program. Reimbursement for VFA will 

12 also be reduced by 30 percent by 2010. 

13 (13) The reduction in reimbursement discour14 ages physicians from continuing to provide access to 

15 DXA or VFA in their offices. Since two-thirds of all 

16 DXA scans are performed in nonfacility settings, 

17 such as physician offices, patient access to bone 

18 mass measurement will be severely compromised 

19 when physicians discontinue providing such tests in 

20 their offices, thereby exacerbating the current under21 utilization of the benefit. 


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1 SEC. 3. MINIMUM PAYMENT FOR BONE MASS MEASURE2 MENT. 

3 (a) IN GENERAL.—Section 1848(b) of the Social Se4 curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 

5 at the end the following: 

6 ‘‘(6) TREATMENT OF BONE MASS SCANS.—Not7 withstanding the provisions of paragraph (1), the 

8 Secretary shall establish a national minimum pay9 ment amount for CPT code 77080 (relating to dual10 energy x-ray absorptiometry) and CPT code 77082 

11 (relating to vertebral fracture assessment), and any 

12 successor to such codes as identified by the Sec13 retary. Such minimum payment amount shall not be 

14 less than 100 percent of the reimbursement rates in 

15 effect for such codes (or predecessor codes) on De16 cember 31, 2006.’’. 

17 (b) EFFECTIVE DATE.—The amendment made by 

18 subsection (a) shall apply to bone mass measurement fur19 nished on or after January 1, 2010. 

20 SEC. 4. STUDY AND REPORT BY THE INSTITUTE OF MEDI21 CINE. 

22 (a) IN GENERAL.—The Secretary of Health and 

23 Human Services shall enter into an arrangement with the 

24 Institute of Medicine of the National Academies to con25 duct a study on the following: 


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1 (1) The ramifications of Medicare reimburse2 ment reductions for DXA and VFA on beneficiary 

3 access to bone mass measurement benefits in general 

4 and in rural and minority communities specifically. 

5 (2) Methods to increase use of bone mass meas6 urement by Medicare beneficiaries. 

7 (b) REPORT.—The agreement entered into under 

8 subsection (a) shall provide for the Institute of Medicine 

9 to submit to the Secretary and the Congress, not later 

10 than 1 year after the date of the enactment of this Act, 

11 a report containing a description of the results of the 

12 study conducted under such subsection and the conclu13 sions and recommendations of the Institute of Medicine 

14 regarding each of the issues described in paragraphs (1) 

15 and (2) of such subsection. 

Æ 


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