Billing and Coding: Bisphosphonate Drug Therapy

This billing and coding article ties coverage for bisphosphonate drug therapy to the clinical indications and medical necessity criteria in LCD L34648 and FDA labeling—IV administration is covered for osteoporosis (including after failure of oral therapy), heterotopic ossification, and bone metastasis when a primary malignant neoplasm is documented. Claims must include supporting diagnosis codes, clinical signs/symptoms, lab results (including pre‑administration serum creatinine), and documentation that the patient was advised about calcium and vitamin D; preventive uses are excluded and services beyond established parameters may be reviewed or denied.

"Intravenous bisphosphonate administration is covered for treatment of osteoporosis when medical record documents need for IV route, including description of treatment failure of oral or self‑admini..."

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