Imaging · Wrist

Dual-energy X-ray absorptiometry bone density measurement at peripheral sites, such as the forearm, wrist, or heel.

3 sources ↓

Medicare: $31.73
Work RVU: 0.2
Global, days
Region: Wrist

Drawn from CMSMedicare NCD

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Qualifying bone mass measurement indication
Reason a peripheral site was measured, especially if axial DXA was also done
Site and side scanned
Density values and T-scores
Signed interpretation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component TC Modifier 59 Distinct service XU Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

77081 measures bone density at an appendicular site, usually the forearm. It has two real uses. The first is a forearm scan added when hip or spine DXA cannot be interpreted, for example after bilateral hip replacement or with lumbar fusion hardware. The second is a standalone peripheral scan when an axial study is not possible.

Same-day billing with 77080 is where people get stuck. Payers often fold a forearm scan into the axial study unless the report gives a reason for it (invalid hip or spine sites, hyperparathyroidism, body weight over the table limit). Check the current NCCI table for the pair before deciding whether a modifier applies.

For Medicare, 77081 counts toward the same bone mass measurement frequency as other density studies. Hand surgeons treating distal radius fragility fractures may order it, but they usually get more useful information from a full axial DXA.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (0.2) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.95) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.2
Practice expense RVU	0.73
Malpractice RVU	0.02
Total RVU	0.95
Medicare national rate	$31.73
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$31.73
HOPD (APC 5521) Hospital outpatient department	$88.91

Common denial reasons

The recurring reasons claims for CPT 77081 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billed with 77080 without documentation that axial sites were invalid or another accepted reason
Repeat within the frequency window
Same-day 77080 and 77081 with no explanation of why both were needed
Diagnosis does not support bone mass measurement
No interpretation report

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01Can 77080 and 77081 be billed on the same day?

Only with a documented reason, such as uninterpretable hip or spine sites. Without one, expect the forearm scan to be denied as part of the axial study.

02What does 77081 measure?

Bone density at a peripheral site, most often the forearm, sometimes the heel.

03Does 77081 count toward Medicare's DXA frequency limit?

Yes. It is a bone mass measurement and falls under the same frequency rules.