Q&A: Reporting 2020 Category III CPT codes for bone strength and fracture risk assessments

Q: Can you please explain appropriate billing and reporting of Category III codes 0554T-0557T for biomechanical assessments?

A: The American Medical Association recently introduced new Category III codes, which went into effect on July 1, for bone strength and fracture risk assessments. These codes include:

• 0554T, bone strength and fracture risk using finite element (FE) analysis of functional data, and bone-mineral density, utilizing data from a computed tomography (CT) scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report
• 0555T, …; retrieval and transmission of the scan data
• 0556T, …; assessment of bone strength and fracture risk and bone mineral density
• 0557T, …; interpretation and report

FE analysis is commonly used by physicians to simulate the mechanical behavior of bone. Code 0554T describes all components of an FE and CT analysis used to measure bone strength and density: the physician’s obtainment of bone mass measurements and data on bone-mineral density using previously obtained CT scans, assessment of bone strength, density, and fracture risk, and a written report.

Codes 0555T-0557T describe individual components of the bone strength and fracture risk analysis. Coders should report as many of these codes as necessary to describe the performed service. However, these codes shouldn’t be reported with all-encompassing code 0554T. A parenthetical note instructs coders not to report code 0554T in conjunction with codes 0555T, 0556T, and 0557T.

Code 0558T (CT scan taken for the purpose of biomechanical CT analysis) is used to report the CT scan specifically taken for biomechanical analysis.

Editor’s note: Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, coding regulatory specialist for HCPro in Middleton, Massachusetts answered this question during the webinar “2020 CPT Update: Coding for New Technology and Procedures.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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