DEXA TBS

We are introducing a new AI enhanced DEXA reporting for our referring providers and patients to have with SimonMed.

Beginning April 21st 2025 if your patient has a SimonMed order for a Dexa Bone Density we should schedule using the EXA Study Description:

9051 BD Bone Density w/TBS (Trabecular Bone Score)

If your patient does not have a SimonMed order we will schedule their Dexa as normal

Only certain sites have this capability, templates have been set up to direct our schedulers

Below are self-pay prices, we still need an order to perform

The total includes the price for the Dexa and the price for the TBS

ORDERS ARE GOOD FOR 1 YEAR. IF EXPIRED, WE NEED TO CALL THE REFERRING DOCTOR TO GET AN UPDATED ONE.

(Refer to the Training Refresher Materials section under the Tools drop down)

Auth requirements:

Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT

Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.  

Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

STAT GUIDELINES

STATS we do try to accommodate same day next day, if it requires auth we schedule out 4 hours or next AM so auth has time to attempt to obtain.

We check the location most convenient to the pt but if we see no openings we offer surrounding sites that may have openings, if surrounding do not have openings as well we are ok to double book following the below guidelines.

*Agents do not have rights to double book so if this occurs they are reaching out to their leads to do the double booking at which time the leads can check thru to make sure it’s an ok spot to add.

If they double book  they should be notifying the patient they are being worked in and may have a wait and notate this was communicated.

A call must be placed to the site only if the following circumstances apply:

·         Clinic/modality is closing within the hour. Example you get call at 3:15pm and that modality closes at 4pm.

·         We are already double-booked and you are needing to add another exam. Example we have two 4pm and you need to add a 3rd (Triple Booking).

·         Only overbook non contrast spots.  Please ensure contrast coverage is available if you are booking a contrast exam.

·         If you are scheduling a specialty exam, there may be limits on certain exams such as: Arthrograms, Fluoro, Diagnostic Mammo’s, Nuc Med, Etc. You must call the site for approval.

·         If you are scheduling an exam that requires authorization please make sure you inform the patient that if authorization is not received by the time of the exam, their appointment   may be postponed. Allow 4 business hours’ time for auth to be obtained.

·         Same day Saturday appointments that require auth must already have auth on file or the patient will not be able to be seen. If exam requires authorization and it has not already been obtained please schedule for Monday to allow time to obtain STAT auth.  

When scheduling the below STAT exam, these cannot be done after 5pm or on weekends.

CTA CHEST WITH CONTRAST W/3D RECON AND THE DIAGNOSIS IS FOR PE (PULMONARY EMBOLISM)

US DUPLEX SCAN LOWER EXTREM VEINS BILATERAL

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (LEFT)

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (RIGHT)

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (LEFT)

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (RIGHT)

OB ULTRASOUNDS FOR VIABILITY

If you are “postponing scheduling” until the next business day please send recap form to the Dr office to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

If you are “postponing scheduling” on a Friday until Monday please send recap form to the Dr office as well as call to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

EXA CODES:

• BD Bone Density Screening (581)

• BD Body Composition (BCA) (1343)

• BD Bone Density W/AFF (7815)

• BD Bone Density Incl Vertebral FX Assess (Diagnostic) (6254)

Scheduling Instructions