Site Alert

You may experience connection interruptions while using L&I's online services Tuesday, May 21, from 7:30 to 11 p.m. due to scheduled maintenance. We apologize for the inconvenience.

Screening & Monitoring Tests for Osteopenia/Osteoporosis

Coverage Decision: Covered with conditions

Bone mineral density testing with dual x-ray absorptiometry (DXA) is a covered benefit with conditions.

Conditions of Coverage

Initial Screening:

Asymptomatic women

  • Women ≥ 65,
    Or
  • Younger women with equivalent ten year fracture risk to women age 65 as calculated by FRAX* (Fracture Risk Assessment) tool or other validated scoring tool.

Men or women

  • Long term exposure to glucocorticoids (i.e. current or past exposure to glucocorticoids for more than 3 months),
  • Androgen deprivation,
    Or
  • Other conditions known to be associated with low bone mass.
Repeat Screening:
  • T-score** > -1.5, 15 years to next screening test
  • T-score -1.5 to -1.99, 5 years to next screening test
  • T-score ≤ -2.0, 1 year to next screening test
    Or
  • Use of medication associated with low bone mass or presence of a condition known to be associated with low bone mass.
Monitoring Treatment:
  • Once treatment for osteoporosis has begun, serial monitoring is not covered
  • Development of a fragility fracture alone is not a covered indication

* FRAX available at: http://www.shef.ac.uk/FRAX/
**T-Score refers to result of a DXA (dual-energy x-ray absorptiometry) scan compared to a reference population.

 

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed screening & monitoring tests for osteopenia/osteoporosis on November 21, 2014. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that the tests are a covered benefit with conditions.  Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.

Implementation of the Decision

A DXA scan may be used only for care of a condition accepted on the claim. All requests require prior authorization.

For State Fund Claims

All requests will be reviewed by L&I’s occupational nurse consultant and claims manager.

  • Complete the Preauthorization Form and fax to:(360) 902-4567
  • For additional information contact the claims manager
    • To obtain the claims manager’s phone number call 1-800-831-5227
    • Attending provider, concurrent care provider or IME log into the Claims & Account Center (CAC)
For Self-Insured Claims

Please contact the self-insured employer (SIE) or their third party administrator (TPA). For a list of SIE/TPAs, go to: http://www.Lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/Default.asp

Billing Codes
CPT ® Codes: 77080 and 77081

 


For more information:
Contact information.


End of main content, page footer follows.

Access Washington official state portal

   © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.

Help us improve