Medimaps Announces Reimbursement by Center for Medicare and Medicaid Services (CMS) for Trabecular Bone Score for Osteoporosis Fracture Risk Assessment

This is the first new reimbursable CPT code for fracture risk assessment in osteoporosis in almost a decade.

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Thursday, July 29, 2021
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Health, Technology, Managed care, Software, Radiology, Biotechnology, Musculoskeletal disorders, Musculoskeletal system, Organ systems, Osteopathies, Aging-associated diseases, Endocrine diseases, Rheumatology, Osteonecrosis, Osteoporosis, Bone density, Medication-related osteonecrosis of the jaw, Bone fracture
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SWITZERLAND, Europe, US, FRANCE, BONE, DELMAS, USA, SIRIS, MANITOBA
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MEDIMAPS GROUP
Summary
Key Points: 
  • This is the first new reimbursable CPT code for fracture risk assessment in osteoporosis in almost a decade.
  • The reimbursement amount was released by CMS last week and will become effective and available January 1, 2022.
  • This is largely a result of the fact that 75% of high-risk patients are not being diagnosed timely4.
  • Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study, Journal of Bone and Mineral Research.


Medimaps Group (www.medimapsgroup.com), a leading global medical imaging software analytics company specializing in the assessment of bone fracture risk, announces that the American Medical Association (AMA) in November approved dedicated Category 1 Current Procedural Terminology (CPT®) codes for Trabecular Bone Score (TBS iNsight™) for DXA and X-Ray imaging. In July CMS approved a reimbursement amount for the Codes. The Category 1 CPT code was submitted to the AMA by the American College of Radiology® and supported by Rheumatology and Endocrinology societies. This is the first new reimbursable CPT code for fracture risk assessment in osteoporosis in almost a decade. The reimbursement amount was released by CMS last week and will become effective and available January 1, 2022.

There is an osteoporotic fracture every three seconds1. The estimated cost of these fractures per year in the USA is $52B and $57B in Europe, according to the National Osteoporosis Foundation and the International Osteoporosis Foundation respectively, and this is expected to grow exponentially with the aging population(2,3). This is largely a result of the fact that 75% of high-risk patients are not being diagnosed timely4. Of those that are sent for bone mineral density (BMD) assessment, roughly 40% are incompletely diagnosed as the BMD5, unlike TBS, only measures quantity but not quality of bone. Medimaps Group’s deep tech FDA 510 (k) clearance solution, TBS, a bone texture analysis related to bone micro-architecture, can reduce substantially these numbers by identifying patients sooner and classifying their fracture risk and improving patient management. It has been shown that 30% of osteopenic patients are reclassified with TBS.6

The CPT code approved by the AMA and now reimbursed by CMS will significantly help provide better access to TBS and thereby improve fracture risk assessment in osteoporosis, and consequently improve patient care.

“We are very pleased about this major breakthrough for the patients who deserve to have access to this advanced medical solution to solve this public health issue. It has always been important for Medimaps to be patient centered without compromising the medical workflow,” said Prof. Didier Hans, CEO of Medimaps Group. “The approval of a Category 1 CPT code by AMA and its reimbursement by CMS is an important step to advancing software analytics in medical imaging. As of today, more than 600,000 TBS procedures per year have been performed in the USA. With this reimbursement more patients will have access to improved bone health assessment.”

About Medimaps Group

Medimaps Group is a leading global medical software analytics company, based in Switzerland with offices in the US and in France. Medimaps Group’s medical imaging software applications based on patented multi-purpose technology with artificial intelligence capabilities provide healthcare solutions that fit seamlessly into the workflow for the benefit of the patient. Its flagship product, the TBS iNsight™ (Osteo) has been used for years in clinical practice worldwide in the field of osteoporosis. It has become the new gold standard for bone texture assessment in routine clinical practice. TBS has gained international recognition with more than 750 peer reviewed scientific publications and is included in many guidelines. www.medimapsgroup.com

CPT is a registered trademark of the American Medical Association.

TBS iNsight is a trademark of Medimaps Group

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  1. Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17(12): p. 1726-33.
  2. https://www.bonehealthpolicyinstitute.org/bone-facts
  3. https://www.osteoporosis.foundation/news/fragility-fractures-cost-european-health-care-systems-eu569-billion-annually-20210607-2118
  4. Delmas, P.D., et al., Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res, 2005. 20(4): p. 557-63
  5. Siris et al. (2004). Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures. Arch Intern Med.; 164(10):1108-1112. doi:10.1001/archinte.164.10.1108
  6. Adapted from Table 3 in Hans et al. J Bone Miner Res. 2011 Nov;26(11):2762-9.Didier Hans et al. (2014). Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study, Journal of Bone and Mineral Research. DOI: 10.1002/jbmr.499

 

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