Advance Beneficiary Notice (ABN) Reminders for Bone Mass Measurements
Per Change Request (CR) 5521, Bone Mass Measurements (BMMs), effective for dates of service on or after January 1, 2007, Medicare will pay for BMM services for dual-energy x-ray absorptiometry (CPT code 77080) when this procedure is used to monitor osteoporosis drug therapy. In addition, new CPT were assigned to BMMs.
Medicare edits will deny claims that are not consistent with revised BMM policy and providers may be liable for noncovered BMMs unless they have issued an advanced beneficiary notice (ABN) as required.
Providers are advised to include the following language in the ABN form when billing Medicare for BMMs:
- "Items or Service" Section:
Insert name of the denied procedure - "Because" Section:
"As specified in chapter 15, section 80.5 of Pub.100-02, Medicare Benefit Policy Manual, Medicare will not pay for this test as it is not reasonable and necessary for Medicare beneficiaries undergoing bone mass measurement."
For more information, see the CMS MLN Matters article MM5521:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm5521.pdf
Page Last Updated: Tuesday, 15-Jul-2008 10:45:18 CDT
