Guidance
Coding & Reimbursement Guidelines for the USA
Guidance on proper coding and billing to support the use of SkeletonPlanner in clinical practice across hospital outpatient departments, physician offices, and imaging centers.
CMS has assigned a Level 1 Diagnostic APC and a specific HCPCS code, enabling reimbursement across hospital outpatient departments, physician offices, and imaging centers. Use the tables and notes below to guide accurate coding and billing.
| HCPCS Code | Description | Hospital Outpatient TC¹ | Non-Facility TC¹ (POS 11) | Physician PC² |
|---|---|---|---|---|
| G0566 | 3D radiodensity-value bone imaging, algorithm derived from previous magnetic resonance examination of the same anatomy. | $156.46 | Carrier-Priced | Carrier-Priced (see crosswalk) |
¹ Technical Component · ² Professional Component
Hospital Outpatient
SkeletonPlanner is reimbursable in the hospital outpatient setting by billing the technical component using HCPCS code G0566. This code is paid through the Outpatient Prospective Payment System (OPPS) under APC group 5721, with a national average payment of $156.46, adjusted for each hospital provider's locality.
Non-Facility
Office, Imaging Center
In an office or imaging center setting, SkeletonPlanner may be billed globally or separately for the technical and professional components using HCPCS code G0566. The reimbursement rate is carrier-priced (i.e., set by the Medicare Administrative Contractor) and is not published by CMS.
Physician
Physicians may bill for the interpretation of SkeletonPlanner images using HCPCS code G0566 with modifier -26. The reimbursement rate is carrier-priced and will be determined by each Medicare Administrative Contractor (MAC). Because this code has no assigned Relative Value Units (RVUs), providing a crosswalk code to the payer offers a benchmark for payment. Potential crosswalk codes include:
| CPT© Code | Description | National Average |
|---|---|---|
| 72125-26 72129-26 72131-26 | CT Cervical, Thoracic, Lumbar without contrast | $45.29 |
FAQs
Can G0566 be billed multiple times per date of service?
Currently there is no Medically Unlikely Edit restricting the billing for multiple bone imaging studies for the same date of service, and G0566 is not subject to Multiple Procedure Payment Reduction (MPPR).
Is there a list of approved ICD-10 codes?
There is no official list of approved ICD-10 codes. However, the diagnosis codes that supported the original MRI scan are assumed to support billing for SkeletonPlanner.
Is prior authorization required?
As a new code, it is currently not included on prior authorization lists. We recommend following your existing prior authorization workflows.
Need support?
We're here to help with billing questions
Presurgeo is working with providers and payers to establish coverage and reimbursement for SkeletonPlanner. For billing questions and support, contact our team.