My provider billed a claim for 76075 and 76076 the same date of service, and the 76076 was denied. Why?
CPT codes 76075 and 76076 are both bone density studies. These codes are used to report services prior to 010107. For services done 010107 and after, CPT codes 76075 and 76076 are to be reported using CPT codes 77080 and 77081 respectively. The bone density testing represented by codes 76075/77080 is for the measurement of an axial skeleton site whereas 76076/77081 is measurement of a peripheral or appendicular skeleton site. The national coverage for measurement of bone density on qualified individuals is one test every 2 years. We are seeing providers doing both of these studies on the same date which amounts to the every 2 year benefit being exceeded on a single day. In many cases, we have seen providers cite the same diagnosis for both tests which raises further questions as to whether both tests done the same date of service are medically necessary. In the rare incidence that a second bone density test is needed the same date of service due to another having been inconclusive, pro
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- My provider billed a claim for 76075 and 76076 the same date of service, and the 76076 was denied. Why?
