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Billing code 77089: Trabecular bone scoreMedicare rate & RVUs

Reports DXA-based trabecular bone score analysis with a fracture-risk assessment, adding microarchitecture information to bone-density evaluation.

CMS RVU26DEffective Oct 1, 2026109 payment localities67.4K Medicare services in 2024

Medicare pays $39.75 for 77089 nationally in the office. Local office rates run $34.74–$54.19.

Medicare rate · 77089

Trabecular bone score

Work RVUs
0.2
Total RVUs
1.19
Global days
XXX

National rate · 2026

$39.75

Office setting, before claim adjustments.

See every locality for 77089 →Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 77089 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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. billing code 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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 payment localities

$34.74 to $54.19

$34.74$44.47$54.19
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

77089 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$35.30Unavailable
Alaska*$44.72Unavailable
Arizona$38.61Unavailable
Arkansas$34.74Unavailable
Atlanta$40.48Unavailable
Austin$41.51Unavailable
Bakersfield$42.56Unavailable
Baltimore/Surr. Cntys$42.43Unavailable
Beaumont$36.79Unavailable
Brazoria$39.29Unavailable

77089 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.

$34.74

$48.33

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

View every state and territory as a table
77089 office rate range by state
State / territoryOffice rate rangeLocalities
AK$44.721
AL$35.301
AR$34.741
AZ$38.611
CA$42.47–$54.1929
CO$41.661
CT$42.561
DC$45.931
DE$39.291
FL$38.84–$42.593
GA$36.48–$40.482
GU$43.721
HI$43.721
IA$36.421
ID$36.651
IL$37.52–$41.434
IN$36.891
KS$36.171
KY$36.101
LA$36.02–$37.992
MA$41.35–$46.132
MD$40.12–$45.933
ME$36.80–$39.092
MI$37.09–$39.312
MN$39.971
MO$35.30–$38.213
MS$35.031
MT$39.751
NC$37.241
ND$39.151
NE$36.651
NH$40.941
NJ$43.06–$45.372
NM$37.291
NV$39.611
NY$37.85–$47.095
OH$36.971
OK$36.091
OR$39.32–$43.162
PA$37.06–$41.382
PR$40.081
RI$40.821
SC$37.161
SD$39.081
TN$36.371
TX$36.79–$41.518
UT$37.721
VA$38.91–$45.932
VI$40.081
VT$38.931
WA$41.29–$47.182
WI$37.711
WV$35.981
WY$39.491

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

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/technical4Global test only.

77089 compared with similar codes

Compare codes · National

5 codes, side by side

  • 77089

    Trabecular bone score0.2 wRVU

    $39.75

  • 77080

    DXA bone density scan0.2 wRVU

    $39.41−$0.34

  • 77085

    DXA bone density0.29 wRVU

    $54.44+$14.69

  • 77092

    TBS interpretation0.2 wRVU

    $10.02−$29.73

  • 77090

    TBS processing0 wRVU

    $3.01−$36.74

How to choose

77080DXA bone density scan
77080 reports axial DXA bone-density measurement. Use 77089 for TBS image analysis and its fracture-risk assessment.
77085DXA bone density
77085 reports axial DXA with vertebral fracture assessment. 77089 reports TBS analysis of a DXA image and fracture-risk information.
77092TBS interpretation
77092 is the professional interpretation and report portion of TBS services. 77089 represents the complete global service.
77090TBS processing
77090 covers technical preparation and transmission of TBS data. 77089 represents the complete service rather than that technical work alone.

Codes related to 77089

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

Codes related to 77089
CodeHow it relatesNational office range
Includes component
77090TBS processingTechnical preparation and transmission of data for TBS analysis.$2.47–$4.03
77091Trabecular bone scoreTechnical calculation service within the TBS code group.$22.84–$38.23
77092TBS interpretationProfessional interpretation and fracture-risk report for TBS.$9.43–$13.41
Often billed with
77080DXA bone density scanAxial DXA bone-density measurement may accompany TBS analysis.$34.57–$54.01
77085DXA bone densityAxial DXA with vertebral fracture assessment may accompany TBS analysis.$47.67–$74.08

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. billing code 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
RVUs for 77089PPRRVU2026_Oct_nonQPP.csv, line 9,022 (RVU26D)

Open CMS sourceHow we calculate rates

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