Does G0130 require prior authorization?

No, G0130 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0130?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.21.

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`G0130`, Single energy x-ray absorptiometry (sexa) bone density study, one or more

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.21

Facility

N/A

Non-Facility

N/A

Documentation Required

All services ordered or rendered to Medicare beneficiaries must be signed; providers/suppliers must notify beneficiaries in writing prior to rendering the service if aware the test/item/procedure may not be covered.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).

The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

When services are likely to be non-covered, use an Advance Beneficiary Notice (ABN) and the appropriate modifier (-GA, -GX, -GY, or -GZ) as applicable; for Part A claims with GA, include occurrence code 32 and the date of the ABN and have Form CMS-R-131 signed by the beneficiary.

Key Coverage Criteria

Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.

9 Active Policies

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

PALMETTO-JJ-L39268, Bone Mass Measurement

PALMETTO-JM-L39268, Bone Mass Measurement

AETNA-CPB-0134, Bone Mass Measurements

CIGNA-A004, Preventive Care Services

A57132, Billing and Coding: Bone Mass Measurement

A58559, Billing and Coding: Independent Diagnostic Testing Facilities (IDTF)

A59040, Billing and Coding: Bone Mass Measurement

`G0130`, Single energy x-ray absorptiometry (sexa) bone density study, one or more

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

G0130, Single energy x-ray absorptiometry (sexa) bone density study, one or more

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`G0130`, Single energy x-ray absorptiometry (sexa) bone density study, one or more