BlueCross BlueShield of Tennessee Medical Policy Manual

Bone Mineral Density Studies

DESCRIPTION

Bone densitometry is a non-invasive technique used to measure bone mineral density (BMD), in order to predict fracture risks. The following technologies are most commonly used:

Osteoporosis is a disease that results in the loss of bone mineral content or bone density. This leads to thinning and weakening of bones and problems such as increase risk of fracture and pain. Individuals with osteopenia have sustained some bone loss and may be at risk for further loss. Primary osteoporosis is usually related to age deficient calcium intake, early menopause, smoking, sedentary life-style without adequate exercise, and a familial history of the disease. Disease or other factors such as drugs or some nutritional conditions that affect the body and cause bone loss cause secondary osteoporosis.

POLICY  

MEDICAL APPROPRIATENESS  

ADDITIONAL INFORMATION

Accepted in accordance with the 1996 Tennessee State Mandate.

If an individual has one or more low trauma fractures, he/she should be considered to have osteoporosis regardless of the bone mineral density (BMD) value.

The World Health Organization (WHO) Fracture Risk Assessment Model (FRAX), in addition to age, gender and bone mineral density; include:

According to Baim, the following are risk factors for osteoporosis and osteoporotic fracture:

Evidence is insufficient to permit conclusions regarding the use of ultrasound densitometry to diagnose osteoporosis.

SOURCES

American Association of Clinical Endocrinologist (AACE). (2003, November/December). AACE medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Retrieved March 6, 2006 from http://www.aace.com/pub/pdf/guidelines/osteoporosis2001Revised.pdf.

American College of Radiology (ACR). (2007). ACR appropriateness criteria™: Osteoporosis and bone mineral density. Retrieved March 16, 2009 from http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMusculoskeletalImaging/OsteoporosisandBoneMineralDensityUpdateinProgressDoc17.aspx.

Baim, S., Binkley, N., Bilezikian, J.P., Kendler, D.L., Hans, D.B., Lewiecki, E.M., et al. (2008). Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD position development conference. Journal of Clinical Densitometry, 11(1), 75-91.

BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2008). Bone mineral density studies. (6.01.01). Retrieved March 3, 2009 from BlueWeb.

Code of Federal Regulations. 42CFR410.31. (2008, October). Bone mass measurement: Conditions for coverage and frequency standards. Retrieved March 16, 2009 from http://edocket.access.gpo.gov/cfr_2008/octqtr/42cfr410.31.htm.

Complete Guide to Medicare Coverage Issues [Computer software]. (2008, November). Bone (mineral) density studies, (NCD 150.3, pp. 2-66).The Ingenix Complete Guide to Medicare Coverage Issues.

ECRI Institute. Health Technology Assessment Information Service. Evidence Reports. (2000, February). Ultrasound bone densitometry for diagnosis of osteoporosis. Retrieved April 11, 2003 from ECRI Institute. (65 articles and/or guidelines reviewed).  

Food and Drug Administration. (1987, March). Center for Devices and Radiological Health. Pre-Market approval decisions for March 1987. Retrieved April 14, 2003 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=44291.

Gallagher, J. C., Ettinger, B., Gass, M. L. S., Kagan, R., McClung, B. L., McClung, M. R., et al. (2002). Position statement: Management of postmenopausal osteoporosis: position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society, 9 (92), 84-101.

Health Technology Advisory Committee (1997, August). Bone densitometry as a screening tool for osteoporosis in postmenopausal women. Retrieved April 14, 2003 from http://www.health.state.mn.us/htac/bone.htm.

Institute for Clinical Systems Improvement. (2000, January). Densitometry as a diagnostic tool for the identification and treatment of osteoporosis in women. Retrieved March 16, 2009 from http://www.icsi.org/guidelines_and_more/technology_assessment_reports/technology_assessment_reports_-_active/densitometry_as_a_diagnostic_tool_for_the_identification_and_treatment_of_osteoporosis_in_women.html.

Institute for Clinical Systems Improvement. (2008, September). Diagnosis and treatment of osteoporosis. Retrieved March 16, 2009 from http://www.icsi.org/osteoporosis/diagnosis_and_treatment_of_osteoporosis__3.html.

Medicare Benefit Policy Manual. Retrieved March 23, 2009 from http://www.cms.hhs.gov/Manuals/downloads/bp102c15.pdf.

National Institutes of Health (NIH) Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. (2001). Osteoporosis prevention, diagnosis, and therapy. JAMA, 283 (6), 785-795.

National Osteoporosis Foundation. (2008). Clinician’s guide to prevention and treatment of osteoporosis. Retrieved March 23, 2009 from http://www.nof.org/professionals/NOF_Clinicians_Guide.pdf.

Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 25 Mandated Insurer or Plan Options: 56-7-2506. Bone mass measurement coverage - Osteoporosis.

U.S. Preventive Services Task Force. (2002, September). Screening for Osteoporosis in Postmenopausal Women. Annals of Internal Medicine, 137, 526-528. Retrieved August 7, 2003 from http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteorr.htm.

World Health Organization. (2007). WHO Scientific Group on the assessment of osteoporosis at primary health care level. Retrieved March 23, 2009 from http://www.who.int/chp/topics/Osteoporosis.pdf.

ORIGINAL EFFECTIVE DATE:  12/1985  

MOST RECENT REVIEW DATE:  9/13/2009   

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.