CPT code 77089: Trabecular bone score, complete service with fracture-risk assessment2026 Medicare rate & RVUs in Iowa
Reports DXA-based trabecular bone score analysis with a fracture-risk assessment, adding microarchitecture information to bone-density evaluation.
In Iowa, Medicare pays $36.42 for 77089 in the office.
Check a contract rate as a % of Medicare · 77089 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Iowa compares for 77089
Across 109 of 109 payment localities, the office rate for 77089 runs from $34.74 in Arkansas to $54.19 in San Benito County, CA. Iowa pays $36.42. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Iowa · this page$36.42
- Los Angeles, CA · California$45.55+$9.13
- Washington, DC area · District of Columbia$45.93+$9.51
- Miami, FL · Florida$42.59+$6.17
- Chicago, IL · Illinois$41.25+$4.83
- Manhattan, NY · New York$45.96+$9.54
- Alaska · Alaska$44.72+$8.30
Other areas in Iowa first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $35.30 | — |
| ArkansasArkansas | $34.74 | — |
| ArizonaArizona | $38.61 | — |
| Bakersfield, CACalifornia | $42.56 | — |
| Chico, CACalifornia | $42.47 | — |
| El Centro, CACalifornia | $42.48 | — |
| Fresno, CACalifornia | $42.47 | — |
| Hanford, CACalifornia | $42.47 | — |
| Madera, CACalifornia | $42.47 | — |
| Merced, CACalifornia | $42.47 | — |
| Modesto, CACalifornia | $42.47 | — |
| Napa, CACalifornia | $49.87 | — |
| Oxnard, CACalifornia | $45.39 | — |
| Redding, CACalifornia | $42.47 | — |
| Rest of CaliforniaCalifornia | $42.47 | — |
| Riverside, CACalifornia | $42.80 | — |
| Sacramento, CACalifornia | $44.75 | — |
| Salinas, CACalifornia | $44.59 | — |
| San Diego, CACalifornia | $45.77 | — |
| Marin County, CACalifornia | $52.99 | — |
| San Francisco, CACalifornia | $52.95 | — |
| San Benito County, CACalifornia | $54.19 | — |
| Santa Clara County, CACalifornia | $54.05 | — |
| San Luis Obispo, CACalifornia | $43.85 | — |
| Santa Cruz, CACalifornia | $46.32 | — |
| Santa Maria, CACalifornia | $44.79 | — |
| Santa Rosa, CACalifornia | $46.79 | — |
| Stockton, CACalifornia | $42.47 | — |
| Vallejo, CACalifornia | $49.82 | — |
| Visalia, CACalifornia | $42.47 | — |
| Yuba City, CACalifornia | $42.47 | — |
| ColoradoColorado | $41.66 | — |
| ConnecticutConnecticut | $42.56 | — |
| DelawareDelaware | $39.29 | — |
| Fort Lauderdale, FLFlorida | $40.97 | — |
| Rest of FloridaFlorida | $38.84 | — |
| Atlanta, GAGeorgia | $40.48 | — |
| Rest of GeorgiaGeorgia | $36.48 | — |
| Hawaii, Guam, HIHawaii | $43.72 | — |
| IdahoIdaho | $36.65 | — |
| East St. Louis, ILIllinois | $38.20 | — |
| Rest of IllinoisIllinois | $37.52 | — |
| Suburban Chicago, ILIllinois | $41.43 | — |
| IndianaIndiana | $36.89 | — |
| KansasKansas | $36.17 | — |
| KentuckyKentucky | $36.10 | — |
| New Orleans, LALouisiana | $37.99 | — |
| Rest of LouisianaLouisiana | $36.02 | — |
| Metropolitan Boston, MAMassachusetts | $46.13 | — |
| Rest of MassachusettsMassachusetts | $41.35 | — |
| Baltimore area, MDMaryland | $42.43 | — |
| Rest of MarylandMaryland | $40.12 | — |
| Rest of MaineMaine | $36.80 | — |
| Southern Maine, MEMaine | $39.09 | — |
| Detroit, MIMichigan | $39.31 | — |
| Rest of MichiganMichigan | $37.09 | — |
| MinnesotaMinnesota | $39.97 | — |
| Metropolitan Kansas City, MOMissouri | $37.77 | — |
| Metropolitan St. Louis, MOMissouri | $38.21 | — |
| Rest of MissouriMissouri | $35.30 | — |
| MississippiMississippi | $35.03 | — |
| MontanaMontana | $39.75 | — |
| North CarolinaNorth Carolina | $37.24 | — |
| North DakotaNorth Dakota | $39.15 | — |
| NebraskaNebraska | $36.65 | — |
| New HampshireNew Hampshire | $40.94 | — |
| Northern New JerseyNew Jersey | $45.37 | — |
| Rest of New JerseyNew Jersey | $43.06 | — |
| New MexicoNew Mexico | $37.29 | — |
| NevadaNevada | $39.61 | — |
| NYC suburbs and Long Island, NYNew York | $47.09 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $43.30 | — |
| Queens, NYNew York | $46.45 | — |
| Rest of New YorkNew York | $37.85 | — |
| OhioOhio | $36.97 | — |
| OklahomaOklahoma | $36.09 | — |
| Portland, OROregon | $43.16 | — |
| Rest of OregonOregon | $39.32 | — |
| Metropolitan Philadelphia, PAPennsylvania | $41.38 | — |
| Rest of PennsylvaniaPennsylvania | $37.06 | — |
| Puerto RicoPuerto Rico | $40.08 | — |
| Rhode IslandRhode Island | $40.82 | — |
| South CarolinaSouth Carolina | $37.16 | — |
| South DakotaSouth Dakota | $39.08 | — |
| TennesseeTennessee | $36.37 | — |
| Austin, TXTexas | $41.51 | — |
| Beaumont, TXTexas | $36.79 | — |
| Brazoria, TXTexas | $39.29 | — |
| Dallas, TXTexas | $39.54 | — |
| Fort Worth, TXTexas | $39.23 | — |
| Galveston, TXTexas | $39.40 | — |
| Houston, TXTexas | $39.95 | — |
| Rest of TexasTexas | $38.01 | — |
| UtahUtah | $37.72 | — |
| VirginiaVirginia | $38.91 | — |
| Virgin Islands, VIUnited States Virgin Islands | $40.08 | — |
| VermontVermont | $38.93 | — |
| Rest of WashingtonWashington | $41.29 | — |
| King County, WAWashington | $47.18 | — |
| WisconsinWisconsin | $37.71 | — |
| West VirginiaWest Virginia | $35.98 | — |
| WyomingWyoming | $39.49 | — |
77089 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$34.74
$48.33
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $44.72 | 1 |
| AL | $35.30 | 1 |
| AR | $34.74 | 1 |
| AZ | $38.61 | 1 |
| CA | $42.47–$54.19 | 29 |
| CO | $41.66 | 1 |
| CT | $42.56 | 1 |
| DC | $45.93 | 1 |
| DE | $39.29 | 1 |
| FL | $38.84–$42.59 | 3 |
| GA | $36.48–$40.48 | 2 |
| GU | $43.72 | 1 |
| HI | $43.72 | 1 |
| IA | $36.42 | 1 |
| ID | $36.65 | 1 |
| IL | $37.52–$41.43 | 4 |
| IN | $36.89 | 1 |
| KS | $36.17 | 1 |
| KY | $36.10 | 1 |
| LA | $36.02–$37.99 | 2 |
| MA | $41.35–$46.13 | 2 |
| MD | $40.12–$45.93 | 3 |
| ME | $36.80–$39.09 | 2 |
| MI | $37.09–$39.31 | 2 |
| MN | $39.97 | 1 |
| MO | $35.30–$38.21 | 3 |
| MS | $35.03 | 1 |
| MT | $39.75 | 1 |
| NC | $37.24 | 1 |
| ND | $39.15 | 1 |
| NE | $36.65 | 1 |
| NH | $40.94 | 1 |
| NJ | $43.06–$45.37 | 2 |
| NM | $37.29 | 1 |
| NV | $39.61 | 1 |
| NY | $37.85–$47.09 | 5 |
| OH | $36.97 | 1 |
| OK | $36.09 | 1 |
| OR | $39.32–$43.16 | 2 |
| PA | $37.06–$41.38 | 2 |
| PR | $40.08 | 1 |
| RI | $40.82 | 1 |
| SC | $37.16 | 1 |
| SD | $39.08 | 1 |
| TN | $36.37 | 1 |
| TX | $36.79–$41.51 | 8 |
| UT | $37.72 | 1 |
| VA | $38.91–$45.93 | 2 |
| VI | $40.08 | 1 |
| VT | $38.93 | 1 |
| WA | $41.29–$47.18 | 2 |
| WI | $37.71 | 1 |
| WV | $35.98 | 1 |
| WY | $39.49 | 1 |
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.
The exact Iowa inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
9,022
- Code
- 77089
- Physician work
- 0.20
- Practice expense
- 0.96
- Malpractice
- 0.03
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.20 | × 1.000 | 0.2000 |
| Practice expense | 0.96 | × 0.915 | 0.8784 |
| Malpractice | 0.03 | × 0.397 | 0.0119 |
| Total RVUs | 1.0903 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Iowa$36.42
Office: (0.2 × 1 + 0.96 × 0.915 + 0.03 × 0.397) × $33.4009 = $36.42
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. |
How 77089 has changed in Iowa
77089 · Office / nonfacility
$36.42
Effective 2026-10-01
The base rate is $0.86 higher than on 2025-10-01, moving from $35.56 to $36.42 (2.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$35.56changed to$36.42
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.97 changed to 0.96
- Practice expense GPCI 0.913 changed to 0.915
- Malpractice GPCI 0.457 changed to 0.397
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$36.90changed to$35.56
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.98 changed to 0.97
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$36.30changed to$36.90
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$37.45changed to$36.30
- Conversion factor 33.8872 changed to 32.7442
- Practice expense GPCI 0.910 changed to 0.913
- Malpractice GPCI 0.441 changed to 0.457
January 1, 2023
RVU23A
$37.81changed to$37.45
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.97 changed to 0.98
- Practice expense GPCI 0.907 changed to 0.910
- Malpractice GPCI 0.425 changed to 0.441
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
No ratechanged to$37.81
Held through RVU22B, RVU22C, RVU22D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $36.42 | Not available in this setting | RVU26D |
| 2026-07-01 | $36.42 | Not available in this setting | RVU26C |
| 2026-04-01 | $36.42 | Not available in this setting | RVU26B |
| 2026-01-01 | $36.42 | Not available in this setting | RVU26A |
| 2025-10-01 | $35.56 | Not available in this setting | RVU25D |
| 2025-07-01 | $35.56 | Not available in this setting | RVU25C |
| 2025-04-01 | $35.56 | Not available in this setting | RVU25B |
| 2025-01-01 | $35.56 | Not available in this setting | RVU25A |
| 2024-10-01 | $36.90 | Not available in this setting | RVU24D |
| 2024-07-01 | $36.90 | Not available in this setting | RVU24C |
| 2024-04-01 | $36.90 | Not available in this setting | RVU24B |
| 2024-03-09 | $36.90 | Not available in this setting | RVU24AR |
| 2024-01-01 | $36.30 | Not available in this setting | RVU24A |
| 2023-10-01 | $37.45 | Not available in this setting | RVU23D |
| 2023-07-01 | $37.45 | Not available in this setting | RVU23C |
| 2023-04-01 | $37.45 | Not available in this setting | RVU23B |
| 2023-01-01 | $37.45 | Not available in this setting | RVU23A |
| 2022-10-01 | $37.81 | Not available in this setting | RVU22D |
| 2022-07-01 | $37.81 | Not available in this setting | RVU22C |
| 2022-04-01 | $37.81 | Not available in this setting | RVU22B |
| 2022-01-01 | $37.81 | Not available in this setting | RVU22A |
| 2021-10-01 | Not in this release | Not in this release | RVU21D |
| 2021-07-01 | Not in this release | Not in this release | RVU21C |
| 2021-04-01 | Not in this release | Not in this release | RVU21B |
| 2021-01-01 | Not in this release | Not in this release | RVU21A |
| 2020-10-01 | Not in this release | Not in this release | RVU20D |
| 2020-07-01 | Not in this release | Not in this release | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Iowa rate applies
Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.
- Ackley
- Ackworth
- Adair
- Adel
- Afton
- Agency
- Ainsworth
- Akron
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