CPT code 77089: Trabecular bone score, complete service with fracture-risk assessment2026 Medicare rate & RVUs in California
Reports DXA-based trabecular bone score analysis with a fracture-risk assessment, adding microarchitecture information to bone-density evaluation.
Medicare pays $42.47–$54.19 for 77089 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 77089 covers
Trabecular bone score analysis evaluates texture in a lumbar-spine DXA image to estimate trabecular bone microarchitecture and add fracture-risk information to bone mineral density. It analyzes an existing DXA image rather than acquiring a new bone-density scan. The service is commonly part of osteoporosis assessment, with technical staff or an analysis service preparing the image and a qualified health care professional interpreting the result and reporting fracture risk.
Report 77089 for the complete service represented by this code. CMS identifies it as a global-test-only code: separate codes describe the technical work and professional interpretation when those portions are reported separately. The record should identify the DXA image analyzed, the TBS result, and the interpretation supporting the fracture-risk assessment. CPT provides separate technical codes 77090 and 77091 and a professional interpretation and report code, 77092.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 77089 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$42.47 to $54.19
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $42.56 | Unavailable |
| Chico, CA | $42.47 | Unavailable |
| El Centro, CA | $42.48 | Unavailable |
| Fresno, CA | $42.47 | Unavailable |
| Hanford, CA | $42.47 | Unavailable |
| Los Angeles, CA | $45.55 | Unavailable |
| Madera, CA | $42.47 | Unavailable |
| Marin County, CA | $52.99 | Unavailable |
| Merced, CA | $42.47 | Unavailable |
| Modesto, CA | $42.47 | Unavailable |
| Napa, CA | $49.87 | Unavailable |
| Oxnard, CA | $45.39 | Unavailable |
| Redding, CA | $42.47 | Unavailable |
| Rest of California | $42.47 | Unavailable |
| Riverside, CA | $42.80 | Unavailable |
| Sacramento, CA | $44.75 | Unavailable |
| Salinas, CA | $44.59 | Unavailable |
| San Benito County, CA | $54.19 | Unavailable |
| San Diego, CA | $45.77 | Unavailable |
| San Francisco, CA | $52.95 | Unavailable |
| San Luis Obispo, CA | $43.85 | Unavailable |
| Santa Clara County, CA | $54.05 | Unavailable |
| Santa Cruz, CA | $46.32 | Unavailable |
| Santa Maria, CA | $44.79 | Unavailable |
| Santa Rosa, CA | $46.79 | Unavailable |
| Stockton, CA | $42.47 | Unavailable |
| Vallejo, CA | $49.82 | Unavailable |
| Visalia, CA | $42.47 | Unavailable |
| Yuba City, CA | $42.47 | Unavailable |
How the 77089 rate is calculated
Each of 77089’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 77089
RVUs × geographic indexes × conversion factor
Work0.20
0.20 RVUs× 1.000 GPCI
Practice expense0.96
0.96 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.1900
Conversion factor
$33.4009
Medicare rate
$39.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77089
The CMS indicators that decide how 77089 is paid alongside other services.
CMS payment indicators · 77089
Trabecular bone score, complete service with fracture-risk assessment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 4 | Global test only. |
77089 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 77080DXA bone density scanAxial skeleton, spine or hip
- 77080 reports axial DXA bone-density measurement. Use 77089 for TBS image analysis and its fracture-risk assessment.
- 77085DXA bone densityAxial with fracture assessment
- 77085 reports axial DXA with vertebral fracture assessment. 77089 reports TBS analysis of a DXA image and fracture-risk information.
- 77092TBS interpretationProfessional component only
- 77092 is the professional interpretation and report portion of TBS services. 77089 represents the complete global service.
- 77090TBS processingData preparation and transmission
- 77090 covers technical preparation and transmission of TBS data. 77089 represents the complete service rather than that technical work alone.
77089 billing questions
How does this differ from a standard axial DXA?
An axial DXA measures bone mineral density. TBS analyzes texture in a lumbar-spine DXA image to add information about trabecular microarchitecture and fracture risk.
Can 77089 be reported with an axial DXA?
TBS analysis may accompany an axial DXA when the DXA image is analyzed for TBS and a fracture-risk assessment is provided. The TBS analysis is distinct from the bone-density measurement.
When should the component codes be used instead?
CMS identifies 77089 as a global-test-only code, with separate codes for technical work and professional interpretation. CPT lists 77090 and 77091 for technical services and 77092 for interpretation and reporting.
What documentation supports 77089?
Document the DXA image analyzed, the TBS result, and the professional interpretation addressing fracture risk. The record should make clear that TBS analysis and reporting were performed, not only routine bone-density measurement.
Is 77089 a code for a new DXA scan?
No. TBS analysis evaluates texture in a lumbar-spine DXA image; it does not describe acquisition of a separate bone-density scan.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 77089 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet