D1.15.1 Item 12321 is intended to allow for bone mineral density measurement following a significant change in therapy - eg. a change in the class of drugs - rather than for a change in the dosage regimen.

D1.15.2 An examination under any of these items covers the measurement of 2 or more sites, interpretation and provision of a report. 2 or more sites must include the measurement of bone density of the lumbar spine and proximal femur. If technical difficulties preclude measurement at these sites, other sites can he used for the purpose of measurements. The measurement of bone medical density at both forearms or both heels or in combination is excluded for the purpose of Medicare benefit.

Referrals
D1.15.3 Bone densitometry services are available on the basis of referral by a medical practitioner to a specialist or consultant physician. However, providers of bone densitometry to whom a patient is referred for management may determine that a bone densitometry service is required in line with the provisions of Items 12306, 12309, 12312, 12315, 12318 and 12321.

D1.15.4 For Items 12306 and 12309 the referral should specify the indication for the test, namely:

  1. 1 or more fractures occurring after minimal trauma; or
  2. monitoring of low bone mineral density proven by previous bone densitometry.
D1.15.5 For Item 12312 the referral should specify the indication for the test, namely:
  1. prolonged glucocorticoid therapy;
  2. conditions associated with excess glucocorticoid secretion;
  3. male hypogonadism; or
  4. female hypogonadism lasting more than 6 months before the age of 45.
D1.15.6 For Item 12315 the referral should speedy the indication for the test, namely:
  1. primary hyperparathyroidism;
  2. chronic liver disease;
  3. chronic renal disease;
  4. proven malabsorptive disorders;
  5. rheumatoid arthritis; or
  6. conditions associated with thyroxine excess.
Definitions
D1.15.8 low bone mineral density is present when the bone (organ) mineral density falls more than 1.5 standard deviations below the age matched mean or more than 2.5 standard deviations below the young normal mean at the same site and in the same gender.

D1.l5.9 For Items 12312 and 12318

  1. Prolonged glucocorticoid therapy' is defined as the commencement of a dosage of inhaled glucocorticoid equivalent to or greater than 800 micrograms beclomethasone dipropionate or budesonide per day; or
  2. a supraphysiological glucocorticoid dosage equivalent to or greater than 7.5 mg prednisolone in an adult taken orally per day for a period anticipated to last for at least 4 months.
D1.l5.10 For Items 12312 and 12318
  1. Male hypogonadism is defined as serum testosterone levels below the age matched normal range.
  2. Female hypogonadism is defined as serum oestrogen levels below the age matched normal range.
D1.15.11 For Items l23l5 and l2318
  1. 'Malabsorptive disorders' - malabsorption of fat is defined as faecal fat estimated at greater than 18 gm per 72 hours on a normal fat diet; or
  2. bowel disease with presumptive vitamin D malabsorption as indicated by a sub -normal circulating 25-hydroxyvitamin D levels


Item Number Description
12306 Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for:
  • the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures occurring after minimal trauma; or
  • for the monitoring of low bone mineral density proven by bone densitometry at least 12 months previously.
Measurement of 2 or more sites - 1 service only in a period of 24 months - including interpretation and report; not being a service associated with a service to which item 12309, 12312, 12315, 12318 or 12321 applies (Ministerial Determination)
12312 Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:
  • prolonged glucocorticoid therapy;
  • conditions associated with excess glucocorticoid secretion;
  • male hypogonadism; or
  • female hypogonadism lasting more than 6 months before the age of 45.
Where the bone density measurement will contribute to the management of a patient with any of the above conditions measurement of 2 or more sites - 1 service only in a period of 12 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12315, 12318 or 12321 applies (Ministerial Determination)
12315 Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), wing dual energy X-ray absorptiometry, for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:
  • primary hyperparathyroidism;
  • chronic liver disease;
  • chronic renal disease;
  • proven malabsorptive disorders;
  • rheumatoid arthritis or
  • conditions associated with thyroxine excess.
Where the bone density measurement will contribute to the management of a patient with any of the above conditions measurement of 2 or more sites - 1 service only in a period of 24 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12318 or 12321 applies (Ministerial Determination)
12321 Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for the measurement of bone density 12 months following a significant change in therapy for:
  • established low bone mineral density; or
  • the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures occurring after minimal trauma.
Measurement of 2 or more sites - 1 service only in a period of 12 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12315 or 12318 applies (Ministerial Determination).


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