G0130 HCPCS code: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0130 is the HCPCS Level II code for single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel). In 2024 Medicare paid an average of $27.42 per service for G0130 across 213 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 7% from 2022 to 2024 (199 to 213 services). In 2024, about 28 clinicians billed Medicare for G0130 for 213 beneficiaries; Texas, Tennessee, New York accounted for 55% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | I4B |
| Added | 1998-07-01 |
| Last action effective | 1998-07-01 |
Who bills G0130 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 28 |
| Medicare beneficiaries | 213 |
| States with claims | 8 |
| Share of services in top 3 states (Texas, Tennessee, New York) | 55% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0130, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 199 | 199 | $27.70 | $27.70 |
| 2023 | 152 | 152 | $25.95 | $25.95 |
| 2024 | 213 | 213 | $27.42 | $27.42 |
States with the most G0130 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 61 | $24.17 |
| Tennessee | 27 | $20.70 |
| New York | 25 | $38.52 |
| Illinois | 22 | $37.07 |
| Alabama | 22 | $30.74 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A57132: Billing and Coding: Bone Mass Measurement (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A58559: Billing and Coding: Independent Diagnostic Testing Facilities (IDTF) (Palmetto GBA (MAC - Part B))
- A59040: Billing and Coding: Bone Mass Measurement (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (429 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E21.0 | Primary hyperparathyroidism | 2 |
| E21.3 | Hyperparathyroidism, unspecified | 2 |
| E23.0 | Hypopituitarism | 2 |
| E24.0 | Pituitary-dependent Cushing's disease | 2 |
| E24.2 | Drug-induced Cushing's syndrome | 2 |
| E24.3 | Ectopic ACTH syndrome | 2 |
| E24.4 | Alcohol-induced pseudo-Cushing's syndrome | 2 |
| E24.8 | Other Cushing's syndrome | 2 |
| E24.9 | Cushing's syndrome, unspecified | 2 |
| E28.310 | Symptomatic premature menopause | 2 |
Showing 10 of 429. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G0130
- 1998-07-01: G0130 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0130?
G0130 is the HCPCS Level II code for single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel). Short descriptor: "Single energy x-ray study".
How much does Medicare pay for G0130?
In 2024, the average Medicare payment was $27.42 per service (average allowed $27.42).
Does Medicare cover G0130?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for G0130?
Medicare policy articles that cite G0130 list 429 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include E21.0 (Primary hyperparathyroidism), E21.3 (Hyperparathyroidism, unspecified), E23.0 (Hypopituitarism). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0130 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G01 codes
- G0101 — Cervical or vaginal cancer screening; pelvic and clinical breast examination
- G0102 — Prostate cancer screening; digital rectal examination
- G0103 — Prostate cancer screening; prostate specific antigen test (PSA)
- G0104 — Colorectal cancer screening; flexible sigmoidoscopy
- G0105 — Colorectal cancer screening; colonoscopy on individual at high risk
- G0106 — Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
- G0108 — Diabetes outpatient self-management training services, individual, per 30 minutes
- G0109 — Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- G0117 — Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118 — Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
- G0120 — Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
- G0121 — Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
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Next steps
- Run a reimbursement report for a device billed under G0130
- Watch G0130 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0130
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.