Axial DXA bone density scan of the hips, pelvis, or spine performed together with vertebral fracture assessment in the same session.
- Medicare
- $54.44
- Work RVU
- 0.29
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Qualifying indication for the DXA
- Separate reason for VFA, such as height loss, kyphosis, or steroid use
- Date of last bone density study
- DXA results and VFA findings by vertebral level
- Signed interpretation covering both components
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Two services sit inside 77085: a hip and spine DXA and a vertebral fracture assessment (VFA), which is a lateral DXA image of the thoracic and lumbar spine used to spot compression fractures the patient may not know about. Finding an occult vertebral fracture changes the diagnosis to established osteoporosis and can change treatment, which is why spine and fracture liaison programs like it.
The rule is simple. If both are done in one session, bill 77085 alone. Do not bill 77080 plus 77086. CPT points you to the combined code, and an auditor will call the split unbundling.
The DXA part is subject to Medicare's bone mass measurement frequency limits. VFA coverage criteria are separate and not every payer pays for it, so confirm the patient has a reason for VFA, such as height loss, a history of glucocorticoid use, or back pain suggesting a compression fracture. A note that only says routine screening will not support the VFA portion.
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 (0.29) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.63) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.29 |
| Practice expense RVU | 1.3 |
| Malpractice RVU | 0.04 |
| Total RVU | 1.63 |
| Medicare national rate | $54.44 |
| 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 | $54.44 |
HOPD (APC 5522) Hospital outpatient department | $106.81 |
Common denial reasons
The recurring reasons claims for CPT 77085 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 77080 and 77086 billed separately instead of 77085
- Repeat within the bone density frequency window
- No documented reason for the VFA portion
- Payer does not cover VFA and the claim was not adjusted
- Missing interpretation of the VFA images
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What does 77085 include?
02Can 77085 be billed with 77080?
03Does Medicare cover vertebral fracture assessment?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02Medicare NCD 150.3 Bone (Mineral) Density Studies
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe picks up measured height loss, steroid history, and back pain in the visit note, which supports the vertebral fracture assessment portion.
See how Mira captures CPT 77085 documentation