Aetna · Clinical coverage policy

Aetna Bone Mass Measurements coverage criteria

Aetna CPB 0134 covers bone mass measurement (e.g., DEXA/DXA, QCT, SEXA, radiographic absorptiometry, ultrasound BMD) as medically necessary for individuals who meet at least one defined osteoporosis risk indication, such as estrogen-deficient women, long-term steroid/anticonvulsant/aromatase-inhibitor therapy, primary hyperparathyroidism, vertebral abnormalities on x-ray, fragility fractures, men with hypogonadism/androgen deprivation, and specified screening groups; certain screening indications are covered only for members with preventive services benefits. Repeat testing is generally limited to once every 2 years (more frequent only in specific monitoring situations such as long-term steroid/anticonvulsant therapy or uncorrected primary hyperparathyroidism). VFA by DEXA (to calculate FRAX) and trabecular bone score are covered as adjuncts, while methods such as DPA, DXL, SPA, pulse-echo ultrasound, cone beam CT, deep-learning QCT, finite element analysis, REMS, skin auto-fluorescence AGEs, and urinary phthalate are experimental/investigational, and AI vertebral-compression-fracture triage software (e.g., HealthVCF) is not medically necessary.

Policy CPB 0134 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0134

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0134 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Bone Mass Measurements (CPT 77080), and what gets it denied?

Path
Aetna CPB 0134 covers bone mass measurement (e.g., DEXA/DXA, QCT, SEXA, radiographic absorptiometry, ultrasound BMD) as medically necessary for individuals who meet at least one defined osteoporosis risk indication, such as estrogen-deficient women, long-term steroid/anticonvulsant/aromatase-inhibitor therapy, primary hyperparathyroidism, vertebral abnormalities on x-ray, fragility fractures, men with hypogonadism/androgen deprivation, and specified screening groups; certain screening indications are covered only for members with preventive services benefits. Repeat testing is generally limited to once every 2 years (more frequent only in specific monitoring situations such as long-term steroid/anticonvulsant therapy or uncorrected primary hyperparathyroidism). VFA by DEXA (to calculate FRAX) and trabecular bone score are covered as adjuncts, while methods such as DPA, DXL, SPA, pulse-echo ultrasound, cone beam CT, deep-learning QCT, finite element analysis, REMS, skin auto-fluorescence AGEs, and urinary phthalate are experimental/investigational, and AI vertebral-compression-fracture triage software (e.g., HealthVCF) is not medically necessary. Coverage criteria include: Bone mass measurement using established techniques is medically necessary for individuals meeting ANY ONE of the following criteria (items below); Individuals being monitored to assess the response to or efficacy of osteoporosis drug therapy (only dual-energy x-ray absorptiometry [DEXA/DXA] for this indication); Individuals receiving (or expected to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of prednisone or greater, per day, for more than 3 months; Individuals on long-term anticonvulsant therapy (e.g., phenytoin, phenobarbital); Individuals on long-term aromatase inhibitor therapy; Individuals with celiac sprue; Individuals with primary hyperparathyroidism; Individuals with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture; Men greater than 50 years of age with specific risk factors for osteoporosis (i.e., low body weight, weight loss, or physical inactivity) (Note: covered for members with preventive services benefits only); Men with hypogonadism or receiving androgen deprivation treatment (e.g., leuprolide, histrelin, goserelin); Non-traumatic (fragility) fractures; Screening of men greater than 70 years of age (Note: covered for members with preventive services benefits only); Screening of women who have been determined to be estrogen-deficient (peri- or post-menopausal) (Note: covered for members with preventive services benefits only); Women on long-term (i.e., longer than 2 years) Depo-Provera Contraceptive Injection (CI) therapy; Women with hyperthyroidism; Women with Turner syndrome; Frequency: Repeat bone mass measurements are usually not indicated more frequently than once every 2 years; More frequent (than once every 2 years) bone mass measurements are medically necessary in ONE of the following circumstances (items below); More frequent measurement: For a confirmatory baseline bone mass measurement to permit monitoring of individuals in the future if the initial bone mass test was performed with a technique that is different from the proposed testing method; More frequent measurement: Monitoring of individuals on long-term glucocorticoid (steroid) therapy or anticonvulsant therapy of more than 3 months duration; More frequent measurement: Monitoring of individuals with uncorrected primary hyperparathyroidism (Note: repeat bone mass measurement has no proven value for other indications); Simultaneous axial and appendicular bone mass measurements are medically necessary only in ONE of the following limited circumstances (items below); Simultaneous axial and appendicular: An axial scan to get a baseline measurement for monitoring if osteoporosis is identified with an appendicular scan; Simultaneous axial and appendicular: Appendicular measurements, when artifacts obscure measurement at the axial skeleton; Simultaneous axial and appendicular: Member is diagnosed with uncorrected primary hyperparathyroidism (Note: simultaneous axial and appendicular bone mass measurements have no proven value for other indications); Established methods of bone mass measurement of the axial or appendicular (peripheral) skeleton (ANY of): Dual energy X-ray absorptiometry (DEXA or DXA) OR Quantitative computed tomography (QCT) OR Radiographic absorptiometry (photodensitometry) OR Single energy X-ray absorptiometry (SEXA) OR Ultrasound bone mineral density studies (e.g., Achilles + Bone Sonometer, Sahara, SoundScan); Vertebral fracture assessment (VFA) with dual energy x-ray absorptiometry (DEXA or DXA) (also known as morphometric x-ray absorptiometry) is medically necessary as an adjunct to bone mineral density measurement to calculate FRAX scores; Trabecular bone score is medically necessary for evaluation of fracture risk in persons who meet criteria for bone mass measurement above. Applies to 8 codes: 77080, 77081, 77085, 77086, 77089, 77092, 76977, 77078.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Experimental and investigational / unproven: Bone mass measurement for all other indications (e.g., evaluation of osteoporosis/osteoporotic fractures in persons with schizophrenia who are on anti-psychotic medications, and monitoring individuals who are on anti-depressive agents) for indications other than the ones listed; Experimental and investigational / unproven: Bone mass measurement by dual photon absorptiometry (DPA), dual X-ray and laser (DXL), single photon absorptiometry (SPA), or pulse-echo ultrasound (e.g., Bindex); Experimental and investigational / unproven: Vertebral fracture assessment (VFA) using any imaging modality other than DEXA; Experimental and investigational / unproven: Cone beam computed tomography for detection of low bone mass (including evaluation of post-menopausal osteoporosis); Experimental and investigational / unproven: Deep learning-based quantitative computed tomography for screening osteoporosis; Experimental and investigational / unproven: Finite element analysis for evaluation of fracture risk, rotator cuff, and all other indications (e.g., diagnosis of osteoporosis, guidance to initiate therapy for osteoporosis, and monitoring of therapy) because its clinical value has not been established; Experimental and investigational / unproven: Measurement of advanced glycation end-products (AGEs) by skin auto-fluorescence (SAF) for assessment of fracture risk because its clinical value has not been established; Experimental and investigational / unproven: Radiofrequency echographic multi spectrometry (REMS) for assessment of bone status; Experimental and investigational / unproven: The use of urinary phthalate as a predictor for fracture risk; Not medically necessary: Aetna considers radiological computer-assisted prioritization / artificial intelligence (AI) software (e.g., HealthVCF) not medically necessary to aid in the identification of vertebral compression fractures during computed tomography (CT) scanning of the chest or abdomen, as the software does not provide diagnostic information beyond triage and prioritization of radiological medical images, and should not be used in place of full member evaluation, or relied upon to make or confirm diagnosis; Repeat bone mass measurement has no proven value for indications other than the specified more-frequent-measurement circumstances; Simultaneous axial and appendicular bone mass measurements have no proven value for indications other than the specified limited circumstances. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0134 — Bone Mass Measurements

Coverage criteria

  • Bone mass measurement using established techniques is medically necessary for individuals meeting ANY ONE of the following criteria (items below)
  • Individuals being monitored to assess the response to or efficacy of osteoporosis drug therapy (only dual-energy x-ray absorptiometry [DEXA/DXA] for this indication)
  • Individuals receiving (or expected to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of prednisone or greater, per day, for more than 3 months
  • Individuals on long-term anticonvulsant therapy (e.g., phenytoin, phenobarbital)
  • Individuals on long-term aromatase inhibitor therapy
  • Individuals with celiac sprue
  • Individuals with primary hyperparathyroidism
  • Individuals with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture
  • Men greater than 50 years of age with specific risk factors for osteoporosis (i.e., low body weight, weight loss, or physical inactivity) (Note: covered for members with preventive services benefits only)
  • Men with hypogonadism or receiving androgen deprivation treatment (e.g., leuprolide, histrelin, goserelin)
  • Non-traumatic (fragility) fractures
  • Screening of men greater than 70 years of age (Note: covered for members with preventive services benefits only)
  • Screening of women who have been determined to be estrogen-deficient (peri- or post-menopausal) (Note: covered for members with preventive services benefits only)
  • Women on long-term (i.e., longer than 2 years) Depo-Provera Contraceptive Injection (CI) therapy
  • Women with hyperthyroidism
  • Women with Turner syndrome
  • Frequency: Repeat bone mass measurements are usually not indicated more frequently than once every 2 years
  • More frequent (than once every 2 years) bone mass measurements are medically necessary in ONE of the following circumstances (items below)
  • More frequent measurement: For a confirmatory baseline bone mass measurement to permit monitoring of individuals in the future if the initial bone mass test was performed with a technique that is different from the proposed testing method
  • More frequent measurement: Monitoring of individuals on long-term glucocorticoid (steroid) therapy or anticonvulsant therapy of more than 3 months duration
  • More frequent measurement: Monitoring of individuals with uncorrected primary hyperparathyroidism (Note: repeat bone mass measurement has no proven value for other indications)
  • Simultaneous axial and appendicular bone mass measurements are medically necessary only in ONE of the following limited circumstances (items below)
  • Simultaneous axial and appendicular: An axial scan to get a baseline measurement for monitoring if osteoporosis is identified with an appendicular scan
  • Simultaneous axial and appendicular: Appendicular measurements, when artifacts obscure measurement at the axial skeleton
  • Simultaneous axial and appendicular: Member is diagnosed with uncorrected primary hyperparathyroidism (Note: simultaneous axial and appendicular bone mass measurements have no proven value for other indications)
  • Established methods of bone mass measurement of the axial or appendicular (peripheral) skeleton (ANY of): Dual energy X-ray absorptiometry (DEXA or DXA) OR Quantitative computed tomography (QCT) OR Radiographic absorptiometry (photodensitometry) OR Single energy X-ray absorptiometry (SEXA) OR Ultrasound bone mineral density studies (e.g., Achilles + Bone Sonometer, Sahara, SoundScan)
  • Vertebral fracture assessment (VFA) with dual energy x-ray absorptiometry (DEXA or DXA) (also known as morphometric x-ray absorptiometry) is medically necessary as an adjunct to bone mineral density measurement to calculate FRAX scores
  • Trabecular bone score is medically necessary for evaluation of fracture risk in persons who meet criteria for bone mass measurement above

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Bone Mass Measurements (CPT 77080), and what gets it denied?
Aetna CPB 0134 covers bone mass measurement (e.g., DEXA/DXA, QCT, SEXA, radiographic absorptiometry, ultrasound BMD) as medically necessary for individuals who meet at least one defined osteoporosis risk indication, such as estrogen-deficient women, long-term steroid/anticonvulsant/aromatase-inhibitor therapy, primary hyperparathyroidism, vertebral abnormalities on x-ray, fragility fractures, men with hypogonadism/androgen deprivation, and specified screening groups; certain screening indications are covered only for members with preventive services benefits. Repeat testing is generally limited to once every 2 years (more frequent only in specific monitoring situations such as long-term steroid/anticonvulsant therapy or uncorrected primary hyperparathyroidism). VFA by DEXA (to calculate FRAX) and trabecular bone score are covered as adjuncts, while methods such as DPA, DXL, SPA, pulse-echo ultrasound, cone beam CT, deep-learning QCT, finite element analysis, REMS, skin auto-fluorescence AGEs, and urinary phthalate are experimental/investigational, and AI vertebral-compression-fracture triage software (e.g., HealthVCF) is not medically necessary. Coverage criteria include: Bone mass measurement using established techniques is medically necessary for individuals meeting ANY ONE of the following criteria (items below); Individuals being monitored to assess the response to or efficacy of osteoporosis drug therapy (only dual-energy x-ray absorptiometry [DEXA/DXA] for this indication); Individuals receiving (or expected to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of prednisone or greater, per day, for more than 3 months; Individuals on long-term anticonvulsant therapy (e.g., phenytoin, phenobarbital); Individuals on long-term aromatase inhibitor therapy; Individuals with celiac sprue; Individuals with primary hyperparathyroidism; Individuals with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture; Men greater than 50 years of age with specific risk factors for osteoporosis (i.e., low body weight, weight loss, or physical inactivity) (Note: covered for members with preventive services benefits only); Men with hypogonadism or receiving androgen deprivation treatment (e.g., leuprolide, histrelin, goserelin); Non-traumatic (fragility) fractures; Screening of men greater than 70 years of age (Note: covered for members with preventive services benefits only); Screening of women who have been determined to be estrogen-deficient (peri- or post-menopausal) (Note: covered for members with preventive services benefits only); Women on long-term (i.e., longer than 2 years) Depo-Provera Contraceptive Injection (CI) therapy; Women with hyperthyroidism; Women with Turner syndrome; Frequency: Repeat bone mass measurements are usually not indicated more frequently than once every 2 years; More frequent (than once every 2 years) bone mass measurements are medically necessary in ONE of the following circumstances (items below); More frequent measurement: For a confirmatory baseline bone mass measurement to permit monitoring of individuals in the future if the initial bone mass test was performed with a technique that is different from the proposed testing method; More frequent measurement: Monitoring of individuals on long-term glucocorticoid (steroid) therapy or anticonvulsant therapy of more than 3 months duration; More frequent measurement: Monitoring of individuals with uncorrected primary hyperparathyroidism (Note: repeat bone mass measurement has no proven value for other indications); Simultaneous axial and appendicular bone mass measurements are medically necessary only in ONE of the following limited circumstances (items below); Simultaneous axial and appendicular: An axial scan to get a baseline measurement for monitoring if osteoporosis is identified with an appendicular scan; Simultaneous axial and appendicular: Appendicular measurements, when artifacts obscure measurement at the axial skeleton; Simultaneous axial and appendicular: Member is diagnosed with uncorrected primary hyperparathyroidism (Note: simultaneous axial and appendicular bone mass measurements have no proven value for other indications); Established methods of bone mass measurement of the axial or appendicular (peripheral) skeleton (ANY of): Dual energy X-ray absorptiometry (DEXA or DXA) OR Quantitative computed tomography (QCT) OR Radiographic absorptiometry (photodensitometry) OR Single energy X-ray absorptiometry (SEXA) OR Ultrasound bone mineral density studies (e.g., Achilles + Bone Sonometer, Sahara, SoundScan); Vertebral fracture assessment (VFA) with dual energy x-ray absorptiometry (DEXA or DXA) (also known as morphometric x-ray absorptiometry) is medically necessary as an adjunct to bone mineral density measurement to calculate FRAX scores; Trabecular bone score is medically necessary for evaluation of fracture risk in persons who meet criteria for bone mass measurement above. Applies to 8 codes: 77080, 77081, 77085, 77086, 77089, 77092, 76977, 77078. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental and investigational / unproven: Bone mass measurement for all other indications (e.g., evaluation of osteoporosis/osteoporotic fractures in persons with schizophrenia who are on anti-psychotic medications, and monitoring individuals who are on anti-depressive agents) for indications other than the ones listed; Experimental and investigational / unproven: Bone mass measurement by dual photon absorptiometry (DPA), dual X-ray and laser (DXL), single photon absorptiometry (SPA), or pulse-echo ultrasound (e.g., Bindex); Experimental and investigational / unproven: Vertebral fracture assessment (VFA) using any imaging modality other than DEXA; Experimental and investigational / unproven: Cone beam computed tomography for detection of low bone mass (including evaluation of post-menopausal osteoporosis); Experimental and investigational / unproven: Deep learning-based quantitative computed tomography for screening osteoporosis; Experimental and investigational / unproven: Finite element analysis for evaluation of fracture risk, rotator cuff, and all other indications (e.g., diagnosis of osteoporosis, guidance to initiate therapy for osteoporosis, and monitoring of therapy) because its clinical value has not been established; Experimental and investigational / unproven: Measurement of advanced glycation end-products (AGEs) by skin auto-fluorescence (SAF) for assessment of fracture risk because its clinical value has not been established; Experimental and investigational / unproven: Radiofrequency echographic multi spectrometry (REMS) for assessment of bone status; Experimental and investigational / unproven: The use of urinary phthalate as a predictor for fracture risk; Not medically necessary: Aetna considers radiological computer-assisted prioritization / artificial intelligence (AI) software (e.g., HealthVCF) not medically necessary to aid in the identification of vertebral compression fractures during computed tomography (CT) scanning of the chest or abdomen, as the software does not provide diagnostic information beyond triage and prioritization of radiological medical images, and should not be used in place of full member evaluation, or relied upon to make or confirm diagnosis; Repeat bone mass measurement has no proven value for indications other than the specified more-frequent-measurement circumstances; Simultaneous axial and appendicular bone mass measurements have no proven value for indications other than the specified limited circumstances. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Bone Mass Measurements?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Bone Mass Measurements?
Policy exclusions and limitations: Experimental and investigational / unproven: Bone mass measurement for all other indications (e.g., evaluation of osteoporosis/osteoporotic fractures in persons with schizophrenia who are on anti-psychotic medications, and monitoring individuals who are on anti-depressive agents) for indications other than the ones listed; Experimental and investigational / unproven: Bone mass measurement by dual photon absorptiometry (DPA), dual X-ray and laser (DXL), single photon absorptiometry (SPA), or pulse-echo ultrasound (e.g., Bindex); Experimental and investigational / unproven: Vertebral fracture assessment (VFA) using any imaging modality other than DEXA; Experimental and investigational / unproven: Cone beam computed tomography for detection of low bone mass (including evaluation of post-menopausal osteoporosis); Experimental and investigational / unproven: Deep learning-based quantitative computed tomography for screening osteoporosis; Experimental and investigational / unproven: Finite element analysis for evaluation of fracture risk, rotator cuff, and all other indications (e.g., diagnosis of osteoporosis, guidance to initiate therapy for osteoporosis, and monitoring of therapy) because its clinical value has not been established; Experimental and investigational / unproven: Measurement of advanced glycation end-products (AGEs) by skin auto-fluorescence (SAF) for assessment of fracture risk because its clinical value has not been established; Experimental and investigational / unproven: Radiofrequency echographic multi spectrometry (REMS) for assessment of bone status; Experimental and investigational / unproven: The use of urinary phthalate as a predictor for fracture risk; Not medically necessary: Aetna considers radiological computer-assisted prioritization / artificial intelligence (AI) software (e.g., HealthVCF) not medically necessary to aid in the identification of vertebral compression fractures during computed tomography (CT) scanning of the chest or abdomen, as the software does not provide diagnostic information beyond triage and prioritization of radiological medical images, and should not be used in place of full member evaluation, or relied upon to make or confirm diagnosis; Repeat bone mass measurement has no proven value for indications other than the specified more-frequent-measurement circumstances; Simultaneous axial and appendicular bone mass measurements have no proven value for indications other than the specified limited circumstances. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0134 — Bone Mass Measurements

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0134 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.