X236 – BMD Measurement - DXA (axial technique) - Additional test for other risk factors - two or more sites
OHIP Laboratory Code · Schedule of Benefits
Bone Mineral Density (BMD) measurement by Dual-energy X-ray Absorptiometry (DXA) - by axial technique only. This code is for an additional test due to other risk factors, involving two or more sites.
When to Use
- Use for patients on high-dose glucocorticoid therapy (>20mg Prednisone equivalent/day) requiring annual monitoring, which exceeds the standard 36-month interval for X155.
- Use for patients with confirmed Hypercortisolism or Cushing’s syndrome where clinical management necessitates BMD assessment more frequently than the standard intervals allowed by X148 or X155.
Common Pitfalls
- Billing X236 for routine osteoporosis monitoring in patients who do not meet the specific high-risk criteria (e.g., Cushing's or high-dose steroids) will result in rejection or audit recovery.
- Claiming X236 when only one site is measured; this code strictly requires both hip and spine unless a documented deformity or prosthesis makes one site technically unfeasible.
- Submitting X236 more frequently than once every 12 months, as this is a hard limit in the OHIP schedule.
Billing Tips
- Ensure the clinical indication of high-dose glucocorticoid therapy or Cushing's syndrome is clearly documented in the patient record to justify the 12-month frequency, as this is the primary audit trigger.
- Always bill the technical component (suffix B) and professional component (suffix C) separately to ensure correct processing, but verify the patient is not an inpatient to avoid technical component rejection.
Effective: April 1, 2026
Diagnostic Radiology
Diagnostic
The service must use the axial technique only.
When more than one site is measured, the sites must include both hip and spine. If measurement of both is not technically feasible (due to prosthesis or deformity), the site measured must consist of either hip or spine.
The service is rendered for the prevention and management of osteoporosis or osteopenia.
Patient risk is defined using the fracture risk assessment tool (FRAX) or equivalent.
High risk: estimated risk > 15%.
Medium risk: estimated risk between 10% and 15%.
Low risk: estimated risk < 10%.
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