X237

PDF page 374 / D16

Definition:
      For the purpose of subsequent testing, patient risk is defined according to the threshold for
      osteoporosis pharmacotherapy in alignment with the Osteoporosis Canada 2023 Guideline.
      Levels of patient risk are defined as:
       “high-risk patient” means a patient who meets any of the following thresholds for
       osteoporosis pharmacotherapy:
       1.T-score ≤ -2.5 at one of the following sites: lumbar spine, femoral neck or total hip;
       2.Previous hip or spine fracture, or ≥ 2 other fracture events; or
       3.Estimated 10-year fracture risk ≥ 15% using the fracture risk assessment tool (FRAX) or
         equivalent major osteoporotic fracture assessment tool.
       “non-high-risk patient” means a patient who does not meet any of the above thresholds for
       osteoporosis pharmacotherapy.
   Baseline test (once per lifetime)
 X145 - one site...............................................................................     42.85         40.15
 X146 - two or more sites ................................................................          55.20         48.00
   Subsequent test - non-high-risk patient (once every 60 months or longer)
 X142 - one site............................................................................... 42.85 40.15
 X148 - two or more sites ................................................................      55.20 48.00
   Subsequent test - high-risk patient or therapy monitoring (once every 36 months)
 X149 - one site............................................................................... 42.85 40.15
 X155 - two or more sites ................................................................      55.20 48.00
   Additional test – patient specific risk factors (once every 12-36 months)
 X237 - one site............................................................................... 42.85             40.15
 X236 - two or more sites ................................................................      55.20             48.00
     Payment rules:
     1.Patients are limited to one baseline test (X145 or X146) in their lifetime.
       2.Subsequent test - non-high-risk patient (X142/X148) is limited to a maximum of one test
         rendered every 60 months following the baseline test (X145/X146) or any subsequent test
         (X142/X148/X149/X155) or any additional test (X236/X237).

PDF page 375 / D17

DIAGNOSTIC RADIOLOGY
      BONE MINERAL DENSITY (BMD) MEASUREMENT
                                                                                                                 H          P
                                          3.(X149/X155) for a high-risk patient is limited to a maximum of one test every 36 months
                                            following the baseline test (X145/X146) or any subsequent test (X142/X148/X149/X155) or
                                            any additional test (X236/X237)
                                          4.X149/X155 for therapy monitoring is limited to a maximum of
                                                i. one test rendered not earlier than 36 months after initiating pharmacotherapy; and/or
                                                ii. one test rendered not earlier than 36 months after stopping bisphosphonate therapy.
                                          5.X149/X155 for therapy monitoring is not eligible for payment when rendered earlier than 36
                                            months following X145/X146 or X142/X148 or X149/X155 or X236/X237.
                                          6.X236/X237 for patient specific risk factors are only eligible for payment when the clinical
                                            circumstances require testing more frequently than once every 36 months. Patient specific
                                            risk factors include:
                                                i. a risk factor for secondary osteoporosis consistent with Canadian clinical practice
                                                      guidelines in place at the time of the service; or
                                                ii. a new fragility fracture; or
                                                iii. a risk factor for rapid bone loss.
                                          7.X236/X237 are limited to a maximum of one test every 12 months following any other BMD
                                            services (X145/X146 or X142/X148 or X149/X155 or X236/X237).
                                          8.Canadian clinical practice guidelines and the use of BMD testing is primarily focused on men
                                            and women over age 50, and do not specifically address pediatric or younger adult patients
                                            who may require testing. In patients under 50, BMD testing is not routine practice unless
                                            specific comorbidities are present, or unless fragility fractures have occurred. In these cases,
                                            BMD services are eligible for payment at the frequencies that are clinically appropriate using
                                            the same above fee codes (e.g. X142/X148, X149/X155 or X237/X236).
                                          [Commentary:
                                          1.The 2023 Clinical Practice Guideline for Management of Osteoporosis and Fracture
                                            Prevention in Canada can be found at https://www.cmaj.ca/content/195/39/E1333 and https:/
                                            /www.cmaj.ca/content/cmaj/suppl/2023/10/03/195.39.E1333.DC1/221647-guide-1-at.pdf
                                          2.The Canadian Association of Radiologists (CAR) 2024 Update: Practice Guideline on Bone
                                            Mineral Densitometry Reporting can be found at https://car.ca/wp-content/uploads/2025/05/
                                            CAR-Practice-Guideline-on-Bone-Mineral-Densitometry-Reporting_-2024-Update_2025.pdf
                                          3.Documentation to support the frequency of testing must be made available to the ministry
                                            upon request.
                                          4.Individuals with a 10-year fracture risk <10% may require repeat BMD testing at 5-10 year
                                            intervals.]

Master, record 6684. Record Layout PDF, page 1.

X23720260401999999990000000000000000535500000000000000000040150000000401500

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.