X148 – Subsequent test - low or medium risk patient - two or more sites
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service is a subsequent bone mineral density (BMD) measurement by Dual-energy X-ray Absorptiometry (DXA) for a low-risk patient, rendered for the prevention and management of osteoporosis or osteopenia. The test involves measuring two or more sites, which must include both the hip and spine. If measurement of both sites is not technically feasible (e.g., due to prosthesis or deformity), the measurement of either the hip or spine is acceptable. A 'low risk patient' is defined as a patient who is not a 'high risk patient'. A 'high risk patient' is defined as a patient: 1. at risk for accelerated bone loss (in the absence of other risk factors, patient age is deemed not to place a patient at high risk for accelerated bone loss); 2. with osteopenia or osteoporosis on any previous BMD testing; or 3. with bone loss in excess of 1% per year as demonstrated by previous BMD testing.
When to Use
- Use for a subsequent BMD scan in a patient who remains low-risk and has not shown evidence of osteopenia, osteoporosis, or accelerated bone loss on previous testing.
- Use when the patient has already completed their baseline (X145/X146) and their second low-risk test (X152/X153) and is now returning for a routine follow-up after the mandatory 60-month interval.
Common Pitfalls
- Billing X148 for a patient who has been diagnosed with osteopenia or osteoporosis on a previous scan, as these patients are classified as high-risk and require different coding.
- Submitting the claim before the 60-month threshold has passed since the previous test, which will trigger an automatic rejection.
- Failing to document the technical justification (e.g., hip prosthesis) if the scan was limited to only one site instead of the required hip and spine.
Billing Tips
- Ensure the patient's risk profile is clearly updated in the chart before each scan to justify the continued use of the low-risk code series rather than high-risk alternatives.
- Verify the date of the previous BMD test against the 60-month rule strictly, as the OHIP system enforces this frequency limit based on the date of the last paid service.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate medical records. The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
For the purpose of second and subsequent testing: - 'high risk patient' means a patient: 1. at risk for accelerated bone loss (in the absence of other risk factors, patient age is deemed not to place a patient at high risk for accelerated bone loss); 2. with osteopenia or osteoporosis on any previous BMD testing; or 3. with bone loss in excess of 1% per year as demonstrated by previous BMD testing. - 'low risk patient' means a patient who is not a high risk patient.
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