September 12, 2011

 

BC-11-12
 
 
 

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Bone Mineral Density Studies

A Bone Mineral Density Study is performed to measure the patient’s bone mass.  Bone mineral density is evaluated as a screening test for osteoporosis, to evaluate diseased bone and to review the responses of bone disease to treatment.

Blue Cross and Blue Shield of Kansas’ medical policy for Bone Mineral Density Studies has an original effective date of June 1, 2007 with revisions in both 2009 and 2011. Please view the BCBSKS medical policy for Bone Mineral Density Studies for the criteria that must be met in order for this service to be considered medically necessary.

New guidelines from Medical Review are to request clinical records from the ordering provider that supports the medical necessity of the test for all DEXA Scans, as well as a copy of the test results. These records and test results are used to evaluate the medical necessity of the test. Providing these records with the claim will expedite the processing of the claim.

The provider is encouraged to obtain a signed waiver prior to the services being performed when services do not meet criteria and could be deemed not medically necessary.  Services will be denied as provider write-off, unless the provider obtains a Limited Patient Waiver (LPW) signed by the patient. If a LPW is obtained, do not submit the waiver with the claim.  The signed waiver must be retained in the patient's file.  With a signed LPW, the charges that are not medically necessary will be denied as patient responsibility.  You can append modifier GA to the applicable CPT/HCPCS code(s) and submit the claim electronically. Modifiers should immediately follow the procedure code, with no space in between. 

If you have questions, please contact your provider consultant.

cw