Billing and Coding: Bisphosphonate Drug Therapy

Intravenous bisphosphonate therapy is covered when medically necessary for conditions such as osteoporosis (including documented failure of oral/self-administered therapy), heterotopic ossification, and for bone metastases when a primary malignant neoplasm is documented. Claims must include diagnosis codes supporting medical necessity, pre-administration serum creatinine, documentation of calcium and vitamin D counseling, and justification for IV administration; preventive indications are excluded and services beyond established parameters may be subject to medical review.

"Intravenous bisphosphonate therapy is covered for osteoporosis when the medical record documents treatment failure of oral or self-administered osteoporosis drugs."

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