Vertebral fracture assessment (VFA) is considered medically necessary for the following conditions when it is performed on the same day as DEXA bone density testing (code 77080) and the results of the VFA will have an impact on the care and management of the patient:

• Patients with symptoms of or a confirmed diagnosis of osteoporosis (733.00, 733.01, 733.02, 733.03, 733.09, 733.90).

Payment for the VFA (code 77082) is also eligible in the following instances only when a review of the information in the patient's clinical record establishes the medical necessity for vertebral fracture assessment performed in addition to a DEXA study (code 77080) on the same day and the results of the VFA will have an impact on the care and management of the patient. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage in this situation.

• Patients with a chronic systemic or degenerative disease that contributes to an increased risk of vertebral fractures, but may have a falsely elevated T score - examples include but are not limited to seropositive rheumatoid arthritis and Crohn’s disease;
• Patients with symptoms suggestive of vertebral fracture (for example, acute pain, severe trauma, or impaired mobility) that has not been clinically identified through a prior radiographic study;
• Patients with a history of a non-vertebral fracture in the absence of osteoporosis; examples include but are not limited to fractures of the hip, pelvis, femur or wrist;
• Patients on long term glucocorticoid use without documented osteoporosis.

When VFA is performed for any other reason, or when it is performed alone, the service should be denied as not medically necessary. Further, VFA should be considered not medically necessary in patients who are already undergoing treatment for bone mass loss or vertebral fracture, because the effectiveness of treatment can only be monitored using dual energy x-ray absorptiometry (code 77080). In those instances, VFA does not yield clinically significant additional information that would impact patient care and management. A participating, preferred, or network provider cannot bill the member for the denied service. 

Description

Vertebral fracture assessment using dual x-ray absorptiometry (DXA) is an imaging method for identifying vertebral fractures or deformities in patients at risk for osteoporosis or osteoporotic fractures. It is also called instant vertebral assessment (IVA), morphometric x-ray absorptiometry (MXA), or lateral vertebral assessment (LVA). The fracture assessment technology is an add-on feature to the dual x-ray absorptiometry (DXA) scanner or densitometer. Using this method, lateral images of the spine can be obtained by performing a 10 second, low-dose single energy scan without subjecting the patient to a separate x-ray procedure.

This procedure is typically performed during the same patient encounter for a DXA scan. It provides the physician with a rapid assessment of the presence or absence of vertebral deformity(ies) including, vertebral fractures. Through this new method, the provider can magnify particular areas of interest or view the entire spine at once.

For additional information on bone density studies, refer to Medical Policy Bulletin X-24.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

National Blue Cross Blue Shield Association Medical Policy #6.01.44

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