I 
116TH CONGRESS 
1ST SESSION H. R. 2693 
To amend title XVIII of the Social Security Act to improve access to, 
and utilization of, bone mass measurement benefits under part B of 
the Medicare program by establishing a minimum payment amount under 
such part for bone mass measurement. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 14, 2019 
Mr. LARSON of Connecticut (for himself, Ms. SA´NCHEZ, Mrs. WALORSKI, Mrs. 
BROOKS of Indiana, Mrs. TRAHAN, Mr. MARSHALL, Mr. BYRNE, Ms. 
CLARKE of New York, Mr. COURTNEY, Mr. RODNEY DAVIS of Illinois, 
Mrs. DINGELL, Mr. FITZPATRICK, Mr. HASTINGS, Ms. JOHNSON of 
Texas, Mr. KELLY of Pennsylvania, Mr. KING of New York, Mrs. CARO-
LYN B. MALONEY of New York, and Mr. DAVID P. ROE of Tennessee) 
introduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
access to, and utilization of, bone mass measurement 
benefits under part B of the Medicare program by estab-
lishing a minimum payment amount under such part 
for bone mass measurement. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. FINDINGS. 
The Congress finds the following: 
(1) Osteoporosis is a major public health prob-
lem with 54 million Americans as of 2010 having ei-
ther low bone mass or osteoporosis, responsible for 
over 2 million fractures per year, including over 
300,000 hip fractures. The estimated total cost of 
these fractures is expected to rise to over $25 billion 
by 2025. 
(2) Osteoporosis is a silent disease that often is 
not discovered until a fracture occurs. One out of 
two women and up to one of four men will suffer an 
osteoporotic fracture in their lifetimes. 
(3) Osteoporosis disproportionately impacts 
women, who account for 71 percent of osteoporotic 
fractures, and 75 percent of costs. 
(4) Most women are not aware of their personal 
risk factors for osteoporosis, the prevalence of, or 
the morbidity and mortality associated with the dis-
ease, despite the fact that broken bones due to 
osteoporosis lead to more hospitalizations and great-
er health care costs than heart attack, stroke, or 
breast cancer in women age 55 and above. 
(5) A woman’s risk of hip fracture is equal to 
her combined risk of breast, uterine, and ovarian 
cancer. More women die in the United States in the 
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year following a hip fracture than from breast can-
cer. 
(6) One out of four people who have an 
osteoporotic hip fracture will need long-term nursing 
home care. Half of those who experience osteoporotic 
hip fractures are unable to walk without assistance. 
(7) Approximately 25 percent of women over 
the age of 50 who sustain a hip fracture die in the 
year following the fracture, while a further 20 per-
cent will never leave a nursing facility. 
(8) Bone density testing is more powerful in 
predicting fractures than cholesterol is in predicting 
myocardial infarction or blood pressure in predicting 
stroke. 
(9) Osteoporosis remains both under-recognized 
and under-treated. Over a 7-year period (2007– 
2013), 45 percent of older female Medicare bene-
ficiaries had no DXA bone density test, and 25 per-
cent had only one test. 
(10) Since 2007, Medicare has cut DXA reim-
bursement by over 70 percent. By 2016, the pay-
ment cuts caused a loss of 36 percent of DXA pro-
viders, resulting in a 21 percent decline in 
osteoporosis diagnosis and treatment. 
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(11) A decade of steady decline in hip fractures 
stopped abruptly in 2013. Since then, there have 
been more than 24,000 additional hip fractures, 
costing over $1 billion, leading to 4,800 more deaths 
than expected if the decline had continued. 
SEC. 2. INCREASING ACCESS TO OSTEOPOROSIS PREVEN-
TION AND TREATMENT. 
Section 1848(b) of the Social Security Act (42 U.S.C. 
1395w–4(b)) is amended— 
(1) in paragraph (4)(B)— 
(A) by striking ‘‘and the first 2 months of 
2012’’ and inserting ‘‘the first 2 months of 
2012, 2019, and each subsequent year’’; and 
(B) by striking ‘‘paragraph (6)’’ and in-
serting ‘‘paragraphs (6) and (12)’’; and 
(2) by adding at the end the following: 
‘‘(12) ESTABLISHING MINIMUM PAYMENT FOR 
OSTEOPOROSIS
TESTS.—For 
dual-energy 
x-ray 
absorptiometry services (identified by HCPCS codes 
77080 and 77082 and successor codes 77085 and 
77086 (and any succeeding codes)) furnished during 
2019 or a subsequent year, the Secretary shall es-
tablish a national minimum payment amount under 
this subsection— 
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‘‘(A) for such services identified by 
HCPCS code 77080, equal to $98 (with na-
tional minimum payment amounts of $87.11 for 
the technical component and $10.89 for the 
professional component); 
‘‘(B) for such services identified by 
HCPCS code 77086, equal to $35 (with na-
tional minimum payment amounts of $27.18 for 
the technical component and $7.82 for the pro-
fessional component); and 
‘‘(C) for the bundled code for dual energy 
absorptiometry and vertebral fracture assess-
ment studies identified as HCPCS code 77085, 
equal to $133 (with national minimum payment 
amounts of $114.29 for the technical compo-
nent and $18.71 for the professional compo-
nent). 
Such minimum payment amounts shall be adjusted 
by the geographical adjustment factor established 
under subsection (e)(2) for the services for the re-
spective year.’’. 
Æ 
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