Coding and Reimbursement

Category III CPT® Codes for BCT and BCT with concurrent VFA:


In typical use, retrieval and transmission of the scan data to a centralized testing lab (0555T) is performed by a Radiology department or imaging facility; assessment of bone strength and fracture risk and bone mineral density (0556T) is performed by the centralized testing facility at O.N. Diagnostics; and interpretation and report (0557T) is performed by a physician with expertise in osteoporosis and BCT. Such a physician would typically be the same type of physician who has the medical expertise to interpret results from DXA testing. For BCT with concurrent VFA, a single code (0743T) is used for all steps and modifiers can be used for only the technical ("-TC") and professional ("-26") components. VFA is not available as a stand-alone test. For situations in which either BCT or BCT with concurrent VFA is medically indicated and a patient does not have a previous CT scan that can be utilized for the test, a CT scan can be ordered (0558T) solely for the purposes of an accompanying BCT.

Reimbursement for BCT. BCT and BCT with concurrent VFA are both reimbursed by Medicare when considered reasonable and necessary. As with all diagnostic tests, the physician should document medical necessity in the patient medical record before ordering the test. Coverage by private insurance (including Medical Advantage) will depend on the patient’s plan. The O.N. Diagnostics IDTF accepts insurance from traditional Medicare (“Part B”); all other patients must self-pay. Patients who self-pay may still submit their own reimbursement claim to their plan and can include their itemized bill from O.N. Diagnostics.

For additional reimbursement information, please see VirtuOst Order Instructions.

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