Diagnostic procedure assessing rules in Medicare 011-42050000

This section covers miscellaneous services from Category 2 of the Medicare Benefits Schedule (MBS).

Category 2 services relate to diagnostic procedures and investigations that aid in the diagnosis of medical conditions.

When searching for information regarding diagnostic procedures in the MBS, first refer to the item number. This provides a full description of the item, the item’s schedule fee and if there is an explanatory note containing additional information regarding the item. You can also search the MBS using key words.

All relevant explanatory notes must be reviewed prior to Service Officers providing advice.

If additional clarification of the item description is required, please refer to your Office Manager, Supervisor or Program Adviser.

The Resources page contains a link to the MBS Online page on the Services Australia website.

Benefits for bone densitometry are only available for the confirmation and monitoring of established conditions and specific treatments. Benefits are not available for bone densitometry as a screening measure.

Bone densitometry requirements

The general requirements relating to bone densitometry service are:

• referral by a medical practitioner (providers of bone densitometry can self-determine where the patient has been referred for management)
• only tests performed on dual energy X-ray absorptiometry (DEXA) or quantitative computerised tomography (QCT) machines are eligible for benefits
• the fee and examination for each item covers the measurement of two or more sites, interpretation and provision of a report:
• two or more sites should include the measurement of bone density of the lumbar spine and proximal femur
• if technical difficulties rule out using these sites, other sites can be used for measurement except for measurement at either forearms or both heels or a combination of the two, as these sites are excluded for benefit purposes
• clinical indications, conditions and treatments for which benefits are payable are detailed in the item descriptors and the referral must specify the indication for the test

Bone densitometry in the Schedule

Bone densitometry services are included under Category 2 of the Schedule. If, as a result of the bone densitometry service, an X-ray was considered necessary, for example, X-ray of the hip, the treating specialist (other than a specialist radiologist) could self-determine the x-ray. If the practitioner rendering the bone density service is a specialist radiologist, a separate request would be required for the X-ray.

For information relating to additional necessary services, see Diagnostic imaging assessing rules in Medicare.

Bone densitometry background information

A bone mineral density test is used to measure the mineral content of a person. A high mineral content indicates denser and stronger bones.

A standard deviation is a statistical measure that compares the result of the mineral content against the average bone density for a person of the same age and gender. This calculation is called a T Score.

In people with T Score above 0, it takes between five to ten years for bone density to decrease by one standard deviation.

The benefit for most bone densitometry items is restricted to one per 24 months because the patient’s condition is being managed to prevent further deterioration. As such, unless one of the conditions listed in the item descriptor or the patient has undergone a significant change in therapy, the test would be considered unnecessary.

For more information see MBS Online explanatory notes for Category 2.

The Resources page contains a link to the MBS Online page on the Services Australia website.