X145 – Bone Mineral Density - one site - baseline
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A baseline Bone Mineral Density (BMD) measurement by Dual-energy X-ray Absorptiometry (DXA) is an insured service only when all the following conditions have been met: 1. the service is rendered for the prevention and management of osteoporosis or osteopenia; 2. when more than one site is measured, the sites include both hip and spine and where measurement of both hip and spine is not technically feasible the site measured consists of either hip or spine. This code is for a baseline test of one site.
When to Use
- Use X145 when a patient requires a baseline BMD measurement and technical constraints, such as a hip prosthesis or spinal deformity, prevent the imaging of both the hip and spine.
- Use X145 for the initial diagnostic assessment of a patient where only one site (either hip or spine) is clinically indicated or physically possible to measure for osteoporosis management.
Common Pitfalls
- Billing X145 when a standard dual-site baseline scan (X146) is technically feasible, as the Ministry expects both sites to be measured whenever possible.
- Attempting to bill X145 for follow-up monitoring; this code is strictly restricted to a lifetime baseline measurement and will be rejected if a previous baseline (X145 or X146) is already on the patient's history.
Billing Tips
- Ensure the clinical record explicitly documents the technical justification (e.g., 'hip prosthesis' or 'severe scoliosis') for why only one site was measured, as this is required to justify the use of X145 over X146.
- Verify the patient's history for any prior baseline BMD claims before submission, as the lifetime limit applies to the combined use of X145 and X146.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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