Preventive Care Services: Bone Mass Measurements



    Policies Impacted

    MA00.003n Preventive Care Services
    MA00.005s Experimental/Investigational Services

    Purpose

    The purpose of this notice is to communicate that finite element analysis to detect bone loss and assess fracture risk will no longer be considered experimental/investigational.

    Background

    Quantitative computed tomography-based finite element analysis (QCT/FEA) estimates fracture strength using 3D bone mineral distribution and geometry. The finite element analysis (FEA) is a computer simulation method, which is being investigated as a tool for bone fragility prediction. FEA considers both the individual geometric and the densitometric parameters retrieved from computed tomography imaging. In homogenized continuum level voxel based FE (hvFE) models, voxels are directly converted to hexahedral elements with specific homogenized material properties depending on local bone density. An example of a FEA test is the VirtuOst test. FEA is the central technology used in the proprietary VirtuOst test to conduct a "virtual" stress test for determining breaking strength. This virtual stress test considers the amount of bone mass a patient has, as well as bone size, shape, and internal structure, and provides analysis called biomechanical computer tomography (BCT) analysis, CT-based measurements for BMD and bone strength.

    Coverage

    Retroactively effective as of 7/1/2019, bone mass measurements using finite element analysis (0554T, 0555T, 0556T, 0557T, 0558T) will be covered as a preventive service. Bone mass measurements using an appropriate method are covered as a preventive service once every 24 months.

    Coding

    0554T

    0555T

    0556T

    0557T

    0558T

    Issued on - 12/19/2019


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