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Osteoporosis Management in Women (OMW): Timely Follow-Up After a Fracture
Effective date
Sep 1, 2026
Identified
Sep 1, 2026
Summary
This is a new Medicare Advantage HEDIS quality measure (OMW) effective September 1, 2026, requiring women ages 67-85 with qualifying fractures to receive a bone mineral density (BMD) test or osteoporosis medication within 180 days post-fracture. Billing teams must ensure accurate coding of BMD tests and osteoporosis treatments (including injectables like denosumab, abaloparatide, teriparatide, romosozumab, and zoledronic acid) to capture completed follow-ups and avoid performance gaps.
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What to do
Action · 6 steps
01Immediately (effective September 1, 2026).
02Billing team must update documentation and coding protocols to accurately capture and code all qualifying BMD tests (CPT 76070-76074) and osteoporosis treatments including injectables (denosumab J3111, abaloparatide J3145, teriparatide J3472, romosozumab J3489, zoledronic acid J4694) when administered post-fracture.
03Providers and clinical staff must review monthly OMW reports from the Medicare Advantage plan and identify women ages 67-85 with newly identified qualifying fractures (excluding finger, toe, face, skull).
04Front desk/scheduling staff must prioritize BMD scan orders within the 180-day intervention window and coordinate member outreach to ensure completion before the deadline.
05Billing team must verify that claims for qualifying treatments are submitted with appropriate coding to ensure they are recognized against the OMW measure.
06Compliance staff should implement tracking for OMW gaps to monitor performance toward MY 2027 measurement year targets.
If missed: Failure to complete BMD testing or osteoporosis treatment within 180 days of fracture will result in non-compliance with this Medicare Advantage quality measure, impacting plan performance scores and potential financial incentives.
Codes mentioned
J3111J3145J3323J3472J3489J46947607076071760727607376074
Original notice
Osteoporosis Management in Women (OMW): Timely Follow-Up After a Fracture
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Hints for HEDIS® (and more)MediumEffective May 1, 2021 · PhysicianOsteoporosis screening and fall preventionMediumEffective Oct 1, 2022 · PhysicianAdditional CPT and HCPCS Level II code changesMediumEffective Oct 1, 2019 · Physician / FacilityHints for HEDIS® (and more)MediumEffective May 1, 2022 · PhysicianBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list