CPT 77086
Global XXX ActiveVrt fracture assmt via dxa
CPT 77086 Billing & Documentation Guide
CPT code 77086 (Vrt fracture assmt via dxa) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.17, a non-facility practice expense RVU of 0.85, and a malpractice RVU of 0.02, a total non-facility RVU of 1.04 and facility RVU of 1.04. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $36, though rates vary from $30.41 to $47.6 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 77086, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 77086 with related codes; this code has 8 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 77086 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 77086
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.17 | 0.17 |
| Practice Expense RVU | 0.85 | 0.85 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.04 | 1.04 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 77086
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $39.84 | $39.84 | $37.25 - $47.6 | 29 |
| Florida | $35.46 | $35.46 | $33.82 - $36.92 | 3 |
| Georgia | $33.57 | $33.57 | $31.8 - $35.34 | 2 |
| Illinois | $34.41 | $34.41 | $32.64 - $36.06 | 4 |
| Michigan | $33.28 | $33.28 | $32.35 - $34.2 | 2 |
| North Carolina | $32.59 | $32.59 | $32.59 - $32.59 | 1 |
| New York | $38.53 | $38.53 | $33.12 - $41.04 | 5 |
| Ohio | $32.27 | $32.27 | $32.27 - $32.27 | 1 |
| Pennsylvania | $34.25 | $34.25 | $32.37 - $36.13 | 2 |
| Texas | $34.28 | $34.28 | $32.13 - $36.32 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 77086
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 77086 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0749T | Column 2 (secondary), bundled into primary | Yes | Mutually exclusive procedures |
| 0750T | Column 2 (secondary), bundled into primary | Yes | Mutually exclusive procedures |
| 77078 | Column 2 (secondary), bundled into primary | No | Mutually exclusive procedures |
| 77080 | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
| 77085 | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 77086
What does CPT code 77086 mean? +
CPT code 77086 represents: Vrt fracture assmt via dxa. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 77086? +
The 2026 Medicare national average non-facility payment for CPT 77086 is $36. Rates range from $30.41 to $47.6 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 77086? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 77086? +
This code has 8 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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