The CPT code for a standard DEXA scan is 77080. It covers dual energy X ray absorptiometry of the axial skeleton, meaning the hip, pelvis, and spine. That single fact resolves most of the confusion practices bring to us, but it is only the starting point. Three related codes exist, Medicare enforces a strict frequency rule, and the wrong ICD-10 pairing is the single most common reason these claims bounce back unpaid.

This guide breaks down every code, every pairing rule, and every denial pattern we see across the practices we bill for.

What Is the CPT Code for a DEXA Scan?

CPT code 77080 is the code you bill for a central, or axial, bone density study. The official AMA descriptor reads “dual energy X ray absorptiometry (DXA), bone density study, 1 or more sites, axial skeleton.” Physicians order it to diagnose osteoporosis, assess fracture risk, or track how a patient responds to treatment over time.

Most practices only ever need 77080. It covers the hip and spine scan that makes up the vast majority of DEXA orders in a typical family medicine or internal medicine practice.

77080 vs 77081 vs 77085: What Is the Difference?

Three codes exist because DEXA technology measures different parts of the skeleton for different clinical reasons. Billing the wrong one is a fast way to get a denial even when the scan itself was medically necessary.

Bill only one code per session for the same anatomical category. Pairing 77080 with 77081 on the same date without documentation showing two distinct, medically necessary sites is a common trigger for a National Correct Coding Initiative edit.

What ICD-10 Codes Pair With 77080?

Medicare and commercial payers deny a huge share of DEXA claims for one reason: the ICD-10 code does not support medical necessity for the CPT code billed. Match the diagnosis to the actual reason for the order, not a default screening code out of habit.

Codes we see hold up consistently across payers:

• M81.0, osteoporosis without current pathological fracture
• M80.0, osteoporosis with current pathological fracture
• Z13.820, encounter for screening for osteoporosis
• Z79.52, long term (current) use of systemic steroids
• Z79.83, long term use of aromatase inhibitors, common for oncology patients on bone sparing therapy

Documentation needs to state the clinical reason for the scan in the note itself, not just in the order. A scan ordered for “routine screening” with no risk factors listed will get denied by payers that require age or risk based justification even when Z13.820 is technically the correct code.

 

Does Medicare Cover DEXA Scan CPT Code 77080?

Yes, with conditions. Medicare Part B covers 77080 once every 24 months for patients who meet risk criteria, and it is one of the more consistently reimbursed radiology codes in the Medicare Physician Fee Schedule when documentation is complete.

Coverage generally applies to:

• Postmenopausal women with at least one risk factor for osteoporosis
• Men and women being monitored while on long term steroid therapy
• Patients with vertebral abnormalities suggestive of osteoporosis on prior imaging
• Patients being monitored during an FDA approved osteoporosis drug therapy, at intervals confirming a therapeutic response

The 24 month frequency limit resets based on the last covered scan, not the calendar year. Submitting a second 77080 inside that window without a qualifying exception (a new fracture, a change in therapy, or specific high risk conditions under NCD 150.3) triggers an automatic frequency denial.

How Much Does CPT Code 77080 Reimburse?

Reimbursement depends on locality and place of service, so treat any flat number as a rough planning figure rather than what you will actually collect. National averages for 77080 typically land in the $40 to $75 range under the Medicare Physician Fee Schedule, with the non facility rate paying more than the facility rate because it includes practice expense for the equipment.

Confirm your place of service code matches where the scan happened. POS 11 for a freestanding office pulls the non facility rate. POS 22 for hospital outpatient pulls the lower facility rate, since the hospital bills separately for the equipment and space.

Why Do DEXA Scan Claims Get Denied?

We pulled the denial patterns from our own client accounts across 2026 and three causes account for the overwhelming majority of DEXA rejections.

Mismatched diagnosis and procedure codes. A screening code attached to a scan that was clearly ordered for monitoring, or vice versa, gets flagged before a human ever reviews it.

Frequency violations. A second 77080 inside the 24 month window with no qualifying change in the patient’s condition denies automatically, no matter how well documented the visit was.

Missing or vague medical necessity documentation. “Screening bone density” in the note is not enough for payers that require explicit risk factors. The note needs to name the specific risk, whether that is age, steroid use, or a prior fracture.

None of these are coding problems in the traditional sense. They are documentation and workflow problems that show up as coding denials. Fixing them means catching the gap before the claim submits, not appealing after the fact.

What This Means for Your Practice’s Revenue

A single denied DEXA claim is not a large dollar amount on its own, usually somewhere between $40 and $75. The real cost is the staff time spent identifying the denial, correcting the code, resubmitting, and following up, often 20 to 30 minutes of billing labor for a claim worth less than a typical office visit copay. Multiply that across every DEXA order your practice generates in a year and the labor cost frequently exceeds the value of the scans themselves.

Practices that route radiology coding through certified coders and pair it with active denial management services catch these mismatches before submission instead of after a rejection letter. That single change moves DEXA claims from a recurring administrative drain to a clean, predictable line item inside your broader revenue cycle management workflow.

 

Frequently Asked Questions

What is the CPT code for a DEXA scan?

The standard CPT code for a DEXA scan is 77080. It covers dual energy X ray absorptiometry of the axial skeleton, meaning the hip, pelvis, and spine, and it is the code used for most osteoporosis screening and monitoring.

What is the difference between CPT code 77080 and 77081?

77080 covers the axial skeleton, the hip and spine. 77081 covers the peripheral or appendicular skeleton, such as the wrist, forearm, or heel. They are billed for different anatomical sites and should not both be used for the same session without documentation supporting two distinct, medically necessary scans.

Does Medicare cover CPT code 77080?

Yes. Medicare Part B covers 77080 once every 24 months for patients who meet risk criteria under NCD 150.3, including postmenopausal women with risk factors and patients on long term steroid therapy. A second scan inside that window needs a qualifying exception to avoid a frequency denial.

What ICD-10 code goes with CPT Code 77080?

The most common pairings are M81.0 for osteoporosis without a current fracture, M80.0 for osteoporosis with a current fracture, and Z13.820 for a routine osteoporosis screening. The diagnosis code has to match the actual clinical reason documented in the note, not just the order.

Why did my DEXA scan claim get denied?

The three most common reasons are a mismatched diagnosis and procedure code, a frequency violation from billing within the 24 month Medicare window, and documentation that does not clearly state the patient’s specific risk factors for the scan.

How much does CPT code 77080 pay?

Reimbursement typically falls between $40 and $75 under the Medicare Physician Fee Schedule, depending on locality and place of service. Non facility settings generally pay more than facility settings because the rate includes practice expense for the equipment.