Health Service Codes

Fee Navigator®

    Health Service Code X128

    Bone mineral content determination dual photon absorptiometry with or without vertebral fracture assessment (VFA)

    NOTE:
    1. May only be claimed once every two years from the date of the last service.
    2. For patients that are at high risk or have conditions that require more frequent assessments, text describing the circumstances will be required.
    3. May only be claimed for patients 50 years of age or older unless the patient is referred by a Endocrinology/Metabolism, Gastroenterology, General Surgery, Internal Medicine, Nephrology, Orthopedic, Pediatric (including sub-specialties), Physical Medicine and Rehabilitation or Rheumatology specialist.
    4. Nurse Practitioners and physicians that are part of Cancer Control Alberta may refer for patients under 50 years of age who are at high risk of bone density loss. Text is required on both the referral and the claim to indicate the patient's risk.
    Additional notes:
    • Listed under - DIAGNOSTIC RADIOLOGY:

      As stated in G.R. 11.1.1, claims for services in the Diagnostic Radiology section will not be payable unless the physician has been approved by the CPSA to provide those services.

    Common terms:
    • BMD
    Category:T Test
    Base rate:$142.19

    AMA billing tips:

    • Claims for more frequent BMD's must be submitted with text that states the circumstances of the patients condition, i.e. medication, illness. Please refer to the following guidelines that provide more information.

      Read more

    • ORDERING PHYSICIANS: please note that a BMD may not be ordered for a patient that is less than 50 years of age unless the exam is ordered by one of the qualifying specialties listed in the notes.

      A BMD may only be ordered and completed once every 2 years UNLESS the patient has one of the following clinical indications, this must be noted on the requisition form:

      1. Patient being monitored during a “bisphosphonate holiday”
      2. Patient on therapy in whom there are clinical features to question drug effect (i.e. fracture while on therapy)
      3. Patient is post transplant
      4. Patient has hyperparathyroidism
      5. Patient on supraphysiologic prednisone longer than 12 months
      Read more

    • REFERRING PROVIDERS: please note that you are part of Cancer Control on the referral so the appointment can be made with minimal complication.

      Read more

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    XRAYCINEYesIncrease Base To150%
    XRAYSTEREOYesIncrease By$17.58

    Governing Rules:

    No Governing Rules.

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