[Intl_DxMedPhys] [EXTERNAL] Re: QCT Bone Density vs DXA for routine screening

Mon Mar 31 17:38:10 EDT 2025

Hi All,

I came across another BMD technology that might be appropriate for Ms. Elmer's client if reimbursement is possible, but I know even less about it. Echolight has a product that is ultrasound-based, non-ionizing, mobile, FDA-cleared, and purports to have a CPT code. It is not listed in ACR's or ISCD's recommendations. You would still need to cross-calibrate the DXA-to-US with a group of patients.

On this webpage, there is a link to reimbursement info at the bottom. (https://urldefense.com/v3/__https://www.echolightmedical.com/codice-cpt-rems-usa/__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlwHTQdF4$ ) Page 4 of the guide says Medicare has not assigned RVU for the code, 0815T. Maybe the company has an update.

To clarify, there is an older US technology "quantitative ultrasound (QUS)" in the ACR and ISCD recommendations. Echolight is "REMS": https://urldefense.com/v3/__https://pmc.ncbi.nlm.nih.gov/articles/PMC11192661/__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVl62FnUrw$ 

I hope something here can help,
Sam

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> On Behalf Of Fahrenholtz, Samuel J., Ph.D. via Intl_dxmedphys_wd_osu_list
Sent: Friday, March 28, 2025 4:35 PM
To: intl_dxmedphys_wd_osu_list at lists.osu.edu
Subject: [EXTERNAL] Re: [Intl_DxMedPhys] QCT Bone Density vs DXA for routine screening

Hi Ms. Elmer and World, At the risk of being incorrect, I don't think most (any?) opportunistic options are billable for QCT. (Maybe there is an opportunistic CT BMD charge?) The only FDA-cleared QCT vendor I know of is Mindways -
Hi Ms. Elmer and World,

At the risk of being incorrect, I don't think most (any?) opportunistic options are billable for QCT. (Maybe there is an opportunistic CT BMD charge?) The only FDA-cleared QCT vendor I know of is Mindways - I linked their product comparison page. I think QCT can be done concurrently with other abdominal+pelvis indications, but I know don't if the QCT would still be billable. Perhaps QCT needs a specific order for billing. Mindways might clarify that.
https://urldefense.com/v3/__https://www.qct.com/ProdComparison.html__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlggI3_l0$ <https://urldefense.com/v3/__https://www.qct.com/ProdComparison.html__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrfeMpfoZs$>

I have no experience with Mindways, so I can't endorse them. I've come across the company in publications. I have spoken with Mindways at RSNA, and they seemed to be well aware of bone health management, a plus. It seems GE CT has a Mindways package option. https://urldefense.com/v3/__https://services.gehealthcare.com/gehcstorefront/p/E8008KC__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlHdS5zeQ$ <https://urldefense.com/v3/__https://services.gehealthcare.com/gehcstorefront/p/E8008KC__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrfhyaFHmw$>

Making some assumptions about your client's situation, this QCT solution might be appropriate if their BMD screening volumes are low. Indeed, Mindways advertises this use case (linked at bottom of page; https://urldefense.com/v3/__https://www.qct.com/CliniQCT.html__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlfn9BkoE$ <https://urldefense.com/v3/__https://www.qct.com/CliniQCT.html__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrfY1ehujk$>). However, there is the possible downside of getting stuck with QCT. Imagine that your client has sufficient BMD volumes in the future. Switching from QCT to DXA represents a big change and a discontinuity in monitoring patients on medication - doing cross-calibration procedures so the client can move from DXA to QCT and then back seems difficult. Also, even when screening QCT can be concurrent with other indications, patients will need later specific QCT exams for monitoring subsequent treatment and aging. So, the CT might get tied up for monitoring QCT exams. And yes, QCT ionizing radiation dose is much more.

If there's someone with clinical QCT screening experience, I would also love to read your perspective.

In addition to ACR's materials, please consider the International Society for Clinical Densitometry (ISCD) 2023 recommendations, which include multiple modalities and cross-calibration. However, the cross-calibration recommendations are for DXA-to-DXA. I tend to think a DXA-to-QCT or vice versa would be similar to DXA-to-DXA.  https://urldefense.com/v3/__https://iscd.org/official-positions-2023/__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlqEaP2Hk$ <https://urldefense.com/v3/__https://iscd.org/official-positions-2023/__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrfwntdDp4$>
A 2015 research paper that cross-calibrates DXA and QCT - it does not mention billing: https://urldefense.com/v3/__https://www.sciencedirect.com/science/article/abs/pii/S1094695014000365__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVluA4iE1M$ <https://urldefense.com/v3/__https://www.sciencedirect.com/science/article/abs/pii/S1094695014000365__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrfIXSuvpg$>
Finally, here's a not-terrible news release on QCT highlighting clinical experiences: https://urldefense.com/v3/__https://www.medpagetoday.com/special-reports/exclusives/98198__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVl1H_lYvY$ <https://urldefense.com/v3/__https://www.medpagetoday.com/special-reports/exclusives/98198__;!!KGKeukY!wTclrESu_x2IrirxbBlAyCpidhBh8QbaZD_qL56rx8L6BQRH-GVdBcAQ78D3eqfCtjwylfpYzGgaqMkBQRqJxR29N2G2JAiYME0BMs4JoSrf6wP7kZs$>

Have a good weekend y'all,

Samuel Fahrenholtz, PhD, DABR
Consultant in Radiology (Diagnostic Physics)
Mayo Clinic Arizona
Assistant Professor Mayo Clinic College of Medicine and Science

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+fahrenholtz.samuel=mayo.edu at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+fahrenholtz.samuel=mayo.edu at lists.osu.edu>> On Behalf Of delmer--- via Intl_dxmedphys_wd_osu_list
Sent: Friday, March 28, 2025 3:35 PM
To: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: [EXTERNAL] [Intl_DxMedPhys] QCT Bone Density vs DXA for routine screening

I've had a client ask about performing routine bone density screening using QCT rather than DXA. They are asking because they are a small rural hospital and their DXA scanner needs to be replaced. They would prefer to add the software
I've had a client ask about performing routine bone density screening using QCT rather than DXA.  They are asking because they are a small rural hospital and their DXA scanner needs to be replaced.  They would prefer to add the software to their relatively new CT scanner than to replace the DXA scanner.

I did a little research and learned the following:

ACR Appropriateness Criteria
https://urldefense.com/v3/__https://acsearch.acr.org/docs/69358/narrative/__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlWbmqfrg$ <https://urldefense.com/v3/__https://acsearch.acr.org/docs/69358/narrative/__;!!KGKeukY!xv65QrCa9w7CzPTZSd84ns-hnLWcQd64LsZRL58bX-Fczvk4UHxsN4HtuVvPDO6R-TLmk3s-eCS5Fi-whOwOZF29bIRQnt94LH88zWmj$>

Quantifying the Opportunity and Economic Value of Bone Density Screening Using Opportunistic CT: A Medicare Database Analysis
Gyftopoulos, Soterios et al. Journal of the American College of Radiology, Volume 22, Issue 3, 349 - 357
https://urldefense.com/v3/__https://www.jacr.org/article/S1546-1440(24)00837-8/fulltext__;!!KGKeukY!wvWLW3IwzjHCWsPRt_TX_csALRTyKePj7andN5vz3ztT-92KkZHk9UsANxcoxFHcCGtNbpn-t4gjQZKIQgMidNV4r2BuvyO6iupgax-B2aVlUyFuSY4$ <https://urldefense.com/v3/__https://www.jacr.org/article/S1546-1440(24)00837-8/fulltext__;!!KGKeukY!xv65QrCa9w7CzPTZSd84ns-hnLWcQd64LsZRL58bX-Fczvk4UHxsN4HtuVvPDO6R-TLmk3s-eCS5Fi-whOwOZF29bIRQnt94LLRhgcnq$>

Most of the relevant literature I've read refers to bone density screening using "opportunistic CT".  I've not seen any literature suggesting routine bone density screening with QCT in lieu of DXA.  Although the ACR Appropriateness Criteria reflects that it "may be appropriate" in 5 of the 6 variants described, the text seems to strongly support it only for Variant 6 (Initial imaging in males and females greater than or equal to 50 years of age. Suspected osteoporosis. Advanced degenerative changes of the spine with or without scoliosis, or other conditions that may spuriously elevate BMD).

According to the ACR Appropriateness Criteria, the radiation exposure from the QCT is 10-100 times greater than the exposure from the DXA (<0.1mSv for DXA; 1-10 mSv for QCT).

I'm told that there is a CPT code for it (77078).

I'm interested in what more you know about this.

Are other facilities using QCT for routine bone density screening?

Diane M. Elmer, M.S., DABR, CHP
Medical Physicist
Medical Physics Consultants, Inc.
Cell:  (217) 553-3049
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