Imaging · Spine

Vertebral fracture assessment using lateral DXA imaging of the thoracic and lumbar spine, performed without a same-session bone density measurement.

2 sources ↓

Medicare: $34.74
Work RVU: 0.17
Global, days
Region: Spine

Drawn from CMS

Documentation requirements

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

Source · Editorial brief grounded in 2 cited references ↓

Clinical reason for VFA, such as height loss, new back pain, or kyphosis
Confirmation that no axial DXA was done in the same session
Vertebral levels assessed
Findings, including grade of any deformity
Signed interpretation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component TC Modifier

What this code covers

Source · Editorial summary grounded in 2 cited references ↓

With 77086, VFA stands alone. The lateral DXA image of the spine is read for vertebral compression deformities. It uses less radiation than spine films and can be done on the same machine used for density testing.

The code is meant for sessions where no axial DXA is done. If density was measured in the same session, use 77085. A practical example: a patient had a DXA eleven months ago, now reports new back pain and two centimeters of height loss, and the physician wants to check for a compression fracture without repeating density inside the frequency window. That is a clean 77086.

If the VFA shows a suspicious deformity, follow-up spine X-rays or MRI are often ordered. Those are separate studies with their own orders. Payer coverage for standalone VFA is uneven, so verify before scheduling and document the specific clinical reason.

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 (0.17) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.04) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.17
Practice expense RVU	0.85
Malpractice RVU	0.02
Total RVU	1.04
Medicare national rate	$34.74
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	$34.74
HOPD (APC 5521) Hospital outpatient department	$88.91

Common denial reasons

The recurring reasons claims for CPT 77086 get rejected.

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

Billed with 77080 on the same date instead of 77085
No documented clinical reason for VFA
Payer does not cover standalone VFA
Missing interpretation
Billed when standard spine X-rays covered the same question the same day

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 2 cited references ↓

01When do you use 77086 instead of 77085?

Use 77086 when vertebral fracture assessment is done without a bone density scan in the same session.

02Is VFA the same as a spine X-ray?

No. VFA uses lateral DXA imaging to screen for compression deformities, and it is coded separately from spine radiographs.

03Does 77086 fall under the bone density frequency limit?

VFA is not a density measurement, and most payers handle it under their own VFA policy. Those policies differ, so check coverage before scheduling and document the reason.