Cigna modified MM 0300 for bone mineral density measurement, effective September 26, 2025. Here's what billing teams need to know about CPT 0691T and 0743T.
Cigna Healthcare updated its bone mineral density coverage policy under MM 0300 in the Cigna system. This revision specifically addresses non-DXA imaging methods for assessing bone density, vertebral fractures, bone strength, and fracture risk — including CT-based analysis. The two codes at the center of this change are 0691T (automated CT-based vertebral fracture analysis) and 0743T (finite element analysis for bone strength and fracture risk). If your practice or facility bills either of these codes to Cigna, this policy shapes whether you get paid or get denied.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Bone Mineral Density Measurement |
| Policy Code | MM 0300 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium-High |
| Specialties Affected | Radiology, endocrinology, orthopedics, internal medicine, rheumatology |
| Key Action | Audit all claims for CPT 0691T and 0743T against MM 0300 criteria before billing Cigna on or after September 26, 2025 |
Cigna Bone Mineral Density Coverage Criteria and Medical Necessity Requirements 2025
The Cigna bone mineral density coverage policy under MM 0300 draws a clear line: this policy governs non-DXA imaging modalities only. If you're billing for standard DEXA (dual-energy X-ray absorptiometry) osteoporosis screening, that falls under Cigna's Administrative Policy on Preventive Care Services (A004) — not MM 0300. Know which bucket your claim belongs in before you submit.
The two non-DXA technologies addressed here are CT-based bone analysis tools. CPT 0691T covers automated analysis of an existing CT study for vertebral fractures. This is a post-processing analysis — it uses a CT scan that's already been performed, not a new scan ordered solely for bone assessment. CPT 0743T uses finite element analysis to calculate bone strength and fracture risk from functional data and bone-mineral density measurements derived from CT.
Medical necessity is the threshold question for both codes. Cigna evaluates whether CT-based bone analysis — rather than standard DXA — is clinically justified for the individual patient. The policy does not treat these as routine alternatives to DXA. They're positioned as distinct technologies with their own coverage criteria, and billing teams should document the clinical rationale clearly in the record before submitting a claim.
Prior authorization requirements under MM 0300 are not explicitly enumerated in this policy revision, but non-DXA bone density services have historically drawn scrutiny from commercial payers. Check Cigna's current prior authorization list for CPT 0691T and 0743T before you schedule or perform the service. A denial for missing prior auth on a Category III code is hard to overturn.
Reimbursement for both codes varies by plan type and region. CPT 0691T and 0743T are Category III (tracking) codes, which means Cigna's reimbursement rates are set at the plan level — there's no national fee schedule equivalent. Confirm your contracted rate, or check whether these codes are even reimbursable under the specific Cigna plan you're billing.
Cigna Bone Mineral Density Exclusions and Non-Covered Indications
The coverage policy makes clear that DXA-based osteoporosis screening is out of scope for MM 0300 entirely. If you're billing CPT 77080 or 77081 for DXA, those claims should route to Cigna's preventive care guidelines under A004, not this policy. Mixing up the two policy pathways is a fast way to get a denial.
CT-based bone analysis billed outside of medical necessity criteria will not be covered. This is particularly relevant for CPT 0743T, which uses finite element analysis — a technically sophisticated method that Cigna is watching closely. Category III codes like 0743T are often treated as experimental or investigational by commercial payers until evidence accumulates and the AMA assigns a permanent Category I code. If Cigna's plan documents or benefit exclusions list either code as experimental, that's your denial reason before the claim is even reviewed clinically.
The real issue here: many payers still treat finite element analysis-based fracture risk tools as investigational. Check the member's specific plan documents. A self-funded employer plan under an ASO arrangement can exclude coverage for these technologies entirely, regardless of what MM 0300 says.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Automated CT analysis for vertebral fracture assessment (using existing CT study) | Coverage when medical necessity criteria met | 0691T | Post-processing of existing CT; not a standalone new scan order |
| Bone strength and fracture risk via finite element analysis of CT-derived data | Coverage when medical necessity criteria met | 0743T | Category III code; verify plan-level reimbursement and prior auth before billing |
| Osteoporosis screening (DXA-based) | Out of scope for MM 0300 | See CPT 77080, 77081 | Routes to Cigna Administrative Policy A004 (Preventive Care Services) |
Cigna Bone Mineral Density Billing Guidelines and Action Items 2025
These are the steps your billing team needs to take before and after the September 26, 2025 effective date.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 0691T and 0743T now. Pull claims from the last 90 days. Check whether they were submitted under MM 0300 or misrouted to preventive care guidelines. Fix the mapping in your billing system before September 26. |
| 2 | Confirm prior authorization requirements for both codes. Log into Cigna's provider portal or call the provider line and verify whether 0691T and 0743T require prior auth under each plan type you bill. Do this before the effective date — not after a denial lands. |
| 3 | Verify plan-level reimbursement rates. Both codes are Category III. There's no standard fee schedule. Pull your contracted rates from Cigna or confirm with your contract management team that these codes are billable under each plan. If the rate is zero or the code is excluded, flag it before you bill. |
| 4 | Separate your DXA billing workflow from non-DXA billing. MM 0300 does not govern DXA screening claims. If your team is routing DXA claims (CPT 77080, 77081) through MM 0300 criteria, stop. Those claims belong under Cigna A004. A workflow error here causes unnecessary claim denials and rework. |
| 5 | Document clinical rationale for non-DXA bone assessment. When billing 0691T or 0743T, the medical record needs to explain why CT-based analysis was used instead of DXA. "Patient had a CT for another indication and 0691T was added" is a legitimate clinical basis — but it needs to be in the record. Cigna medical directors will review documentation on any claim denial appeal. |
| 6 | Flag self-funded Cigna plans for additional review. ASO plan sponsors can exclude these Category III codes regardless of MM 0300. Check benefit documents for each employer group before assuming coverage. If you're not sure which plans in your Cigna book are self-funded, talk to your compliance officer before the September 26 effective date. |
| 7 | Monitor claim denials for 0691T and 0743T starting in October 2025. After the policy change takes effect, watch your denial dashboard. Any uptick in medical necessity denials or experimental/investigational denials for these two codes signals a documentation or coding problem. Catch it in the first billing cycle, not after 90 days of claims have rolled through. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Bone Mineral Density Under MM 0300
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 0691T | CPT (Category III) | Automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density |
| 0743T | CPT (Category III) | Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density derived from computed tomography |
Both codes are Category III tracking codes. That designation alone tells you something: these are emerging technologies without a permanent place in the CPT Category I system yet. Payers — including Cigna — have wide discretion in how they reimburse them, and plan-level exclusions are common.
If your team bills 0691T and 0743T for bone mineral density billing on a regular basis, you need a clean prior authorization process and solid documentation standards in place before claims go out.
Key ICD-10-CM Diagnosis Codes
The MM 0300 policy data does not list specific ICD-10-CM diagnosis codes. Your coding team should link claims for 0691T and 0743T to appropriate diagnosis codes that support medical necessity — such as osteoporosis codes (M80.x, M81.x), vertebral fracture codes, or other relevant musculoskeletal diagnoses documented in the clinical record. Work with your coding team and clinical staff to ensure diagnosis codes reflect the actual clinical indication, not a generic placeholder.
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