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CPT code 77091: Trabecular bone score, technical calculation only2026 Medicare rate & RVUs in North Carolina

Reports the technical computation of a trabecular bone score from DXA data when the calculation is performed separately from data preparation and interpretation.

CMS RVU26DEffective Oct 1, 2026One payment locality6.4K Medicare services in 2024

In North Carolina, Medicare pays $24.83 for 77091 in the office.

$24.83Office (non-facility)
Not available in this settingHospital or facility
−7.1%vs the national office rate ($26.72)

Check a contract rate as a % of Medicare · 77091 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 77091 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 77091 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 77091 covers

This service calculates a trabecular bone score from DXA image data, generally from a lumbar spine bone-density study. The score analyzes image texture as an indicator of trabecular bone microarchitecture and can contribute to fracture-risk assessment. DXA technologists or other technical staff typically perform the software-based calculation in a bone-density or radiology setting; the calculation does not itself provide a clinician’s interpretation.

Report 77091 for the technical calculation when that work is separately performed. CMS classifies it as a technical-component-only service, with interpretation covered by a separate code; 77092 is used for the interpretation and report. Documentation should identify the DXA data processed and support completion of the calculation. Distinguish this service from 77090, which covers preparation and transmission of data, and from 77089, which describes a TBS service that includes calculation with interpretation and a fracture-risk report.

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 North Carolina compares for 77091

Across 109 of 109 payment localities, the office rate for 77091 runs from $22.84 in Arkansas to $38.23 in San Benito County, CA. North Carolina pays $24.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

77091 in North Carolina vs other payment areas
  1. North Carolina · this page$24.83
  2. Los Angeles, CA · California$31.44+$6.61
  3. Washington, DC area · District of Columbia$31.46+$6.63
  4. Miami, FL · Florida$28.31+$3.48
  5. Chicago, IL · Illinois$27.29+$2.46
  6. Manhattan, NY · New York$31.19+$6.36
  7. Alaska · Alaska$28.29+$3.46

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

77091 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$23.28—
ArkansasArkansas$22.84—
ArizonaArizona$25.85—
Bakersfield, CACalifornia$29.12—
Chico, CACalifornia$29.10—
El Centro, CACalifornia$29.10—
Fresno, CACalifornia$29.10—
Hanford, CACalifornia$29.10—

77091 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$22.84

$33.67

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
77091 office rate range by state
State / territoryOffice rate rangeLocalities
AK$28.291
AL$23.281
AR$22.841
AZ$25.851
CA$29.10–$38.2329
CO$28.341
CT$28.821
DC$31.461
DE$26.371
FL$25.73–$28.313
GA$23.94–$27.212
GU$30.201
HI$30.201
IA$24.281
ID$24.431
IL$24.61–$27.694
IN$24.621
KS$24.021
KY$23.761
LA$23.67–$25.212
MA$28.05–$31.802
MD$27.01–$31.463
ME$24.48–$26.362
MI$24.47–$26.032
MN$27.251
MO$23.07–$25.453
MS$22.971
MT$26.721
NC$24.831
ND$26.521
NE$24.481
NH$27.761
NJ$29.18–$30.972
NM$24.601
NV$26.691
NY$25.30–$31.995
OH$24.431
OK$23.821
OR$26.52–$29.562
PA$24.54–$27.872
PR$27.011
RI$27.561
SC$24.671
SD$26.501
TN$24.161
TX$24.32–$28.218
UT$25.101
VA$26.17–$31.462
VI$27.011
VT$26.291
WA$28.04–$32.652
WI$25.381
WV$23.411
WY$26.631

See 77091 in every payment locality

How the 77091 rate is calculated

Each of 77091’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 · 77091

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.79

0.79 RVUs× 1.000 GPCI

Malpractice0.01

0.01 RVUs× 1.000 GPCI

Adjusted RVUs

0.8000

Conversion factor

$33.4009

Medicare rate

$26.72

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

9,024

Code
77091
Physician work
0.00
Practice expense
0.79
Malpractice
0.01

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 77091 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.00× 1.0000.0000
Practice expense0.79× 0.9330.7371
Malpractice0.01× 0.6390.0064
Total RVUs0.7435
Conversion factor× 33.4009

Office rate, North Carolina$24.83

Office: (0 × 1 + 0.79 × 0.933 + 0.01 × 0.639) × $33.4009 = $24.83

Open 77091 in the RVU calculator

Payment rules and modifiers for 77091

The CMS indicators that decide how 77091 is paid alongside other services.

CMS payment indicators · 77091

Trabecular bone score, technical calculation only

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical3Technical component only.

Codes related to 77091

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 77091
CodeHow it relatesOffice range, North Carolina
Often billed with
77092TBS interpretation, professional component onlyCovers the separate interpretation and report for the trabecular bone score.$9.70
77090TBS processing, data preparation and transmissionCovers DXA data preparation and transmission before analysis performed elsewhere.$2.71
77080DXA bone density scan, axial skeleton, spine or hipReports axial DXA bone-density measurement that may provide the data used for TBS.$37.02
Used instead
77089Trabecular bone score, complete service with fracture-risk assessmentDescribes TBS calculation with interpretation and a fracture-risk report.$37.24

How 77091 has changed in North Carolina

77091 · Office / nonfacility

$24.83

Effective 2026-10-01

The base rate is $0.35 higher than on 2025-10-01, moving from $24.48 to $24.83 (1.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $24.48changed to$24.83

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.81 changed to 0.79
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $25.81changed to$24.48

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 0.83 changed to 0.81

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $25.38changed to$25.81

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $26.32changed to$25.38

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $26.62changed to$26.32

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.82 changed to 0.83
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    No ratechanged to$26.62

    Held through RVU22B, RVU22C, RVU22D.

  7. 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.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$24.83Not available in this settingRVU26D
2026-07-01$24.83Not available in this settingRVU26C
2026-04-01$24.83Not available in this settingRVU26B
2026-01-01$24.83Not available in this settingRVU26A
2025-10-01$24.48Not available in this settingRVU25D
2025-07-01$24.48Not available in this settingRVU25C
2025-04-01$24.48Not available in this settingRVU25B
2025-01-01$24.48Not available in this settingRVU25A
2024-10-01$25.81Not available in this settingRVU24D
2024-07-01$25.81Not available in this settingRVU24C
2024-04-01$25.81Not available in this settingRVU24B
2024-03-09$25.81Not available in this settingRVU24AR
2024-01-01$25.38Not available in this settingRVU24A
2023-10-01$26.32Not available in this settingRVU23D
2023-07-01$26.32Not available in this settingRVU23C
2023-04-01$26.32Not available in this settingRVU23B
2023-01-01$26.32Not available in this settingRVU23A
2022-10-01$26.62Not available in this settingRVU22D
2022-07-01$26.62Not available in this settingRVU22C
2022-04-01$26.62Not available in this settingRVU22B
2022-01-01$26.62Not available in this settingRVU22A
2021-10-01Not in this releaseNot in this releaseRVU21D
2021-07-01Not in this releaseNot in this releaseRVU21C
2021-04-01Not in this releaseNot in this releaseRVU21B
2021-01-01Not in this releaseNot in this releaseRVU21A
2020-10-01Not in this releaseNot in this releaseRVU20D
2020-07-01Not in this releaseNot in this releaseRVU20C
2020-04-01Not in this releaseNot in this releaseRVU20B
2020-01-01Not in this releaseNot in this releaseRVU20A
2019-10-01Not in this releaseNot in this releaseRVU19D
2019-07-01Not in this releaseNot in this releaseRVU19C
2019-04-01Not in this releaseNot in this releaseRVU19B
2019-01-01Not in this releaseNot in this releaseRVU19A
2018-10-01Not in this releaseNot in this releaseRVU18D
2018-07-01Not in this releaseNot in this releaseRVU18C
2018-04-01Not in this releaseNot in this releaseRVU18B
2018-01-01Not in this releaseNot in this releaseRVU18AR1
2017-10-01Not in this releaseNot in this releaseRVU17D
2017-07-01Not in this releaseNot in this releaseRVU17C
2017-04-01Not in this releaseNot in this releaseRVU17B
2017-01-01Not in this releaseNot in this releaseRVU17A
2016-10-01Not in this releaseNot in this releaseRVU16D
2016-07-01Not in this releaseNot in this releaseRVU16C
2016-04-01Not in this releaseNot in this releaseRVU16B
2016-01-01Not in this releaseNot in this releaseRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 77091 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

77091 billing questions

Does 77091 include the clinician’s interpretation?

No. It covers the technical calculation only; the interpretation and report are covered by a separate code, 77092.

How does 77091 differ from 77090?

77091 represents the technical TBS calculation. 77090 represents preparation and transmission of DXA data for analysis elsewhere.

When would 77089 be considered instead?

77089 describes a TBS service that includes calculation with interpretation and a fracture-risk report. Use the code that reflects the service actually performed and reported.

What documentation supports 77091?

Document the DXA data used and completion of the technical TBS calculation. The interpretation and report belong to the separate interpretation service.

Is this the code for the DXA scan itself?

No. 77091 reports the TBS technical calculation from DXA data, not the bone-density measurement; 77080 is an axial DXA bone-density code.

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
RVUs for 77091PPRRVU2026_Oct_nonQPP.csv, line 9,024 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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