Medicare Benefits Schedule - Item 12322

Search Results for Item 12322

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Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

12322

12322 - Additional Information

Item Start Date:
01-Nov-2017
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Nov-2017

Group
D1 - Miscellaneous Diagnostic Procedures And Investigations
Subgroup
10 - Other Diagnostic Procedures And Investigations

Bone densitometry, using dual energy X‑ray absorptiometry or quantitative computed tomography, involving the measurement of 2 or more sites (including interpretation and reporting) for measurement of bone mineral density, if:

(a) the patient is 70 years of age or over; and

(b) the t‑score for the patient's bone mineral density is less than ‑1.5 but more than ‑2.5;

other than a service associated with a service to which item 12306, 12312, 12315, 12320 or 12321 applies

For any particular patient, once only in a 2 year period 

Fee: $102.40 Benefit: 75% = $76.80 85% = $87.05

(See para DN.1.18 of explanatory notes to this Category)


Associated Notes

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

DN.1.18

Bone Densitometry - (Items 12306 to 12322)

Definitions

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.

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

Items 12320 and 12322 enable the payment of a Medicare benefit for a bone densitometry service performed on a patient aged 70 years or over. Patients 70 years and over are eligible for an initial screening study. 

Patients assessed as having a normal study or mild osteopenia as measured by a t-score down to -1.5 are eligible for one scan every 5 years (item 12320).

Patients with moderate to marked osteopenia as measured by a T-score of -1.5 to -2.5 are eligible for one scan every two years (item 12322).

An examination under any of these items covers the measurement of 2 or more sites, interpretation and provision of a report; all performed by a specialist or consultant physician in the practice of his or her specialty.  Two or more sites must include the measurement of bone density of the lumbar spine and proximal femur. The measurement of bone mineral density at either forearms or both heels or in combination is excluded for the purpose of Medicare benefit, unless necessary for specific clinical indications (see below).

Patients unable to have a lumbar spine or proximal femur measurement taken

The recommended alternative measurement for patients who have been referred for a dual energy x-ray absorptiometry (DEXA) bone densitometry scan who are unable to have a lumbar spine or proximal femur measurement taken is the distal forearm, e.g. patients with spinal fusions or bilateral hip prostheses. Patients unable to have a lumbar spine or proximal femur measurement taken who have been referred for a quantitative computed tomography (QCT) scan are not subject to the two site measurements requirement. For these patients one site for which a QCT measurement can be appropriately referenced is sufficient.  

Professional Supervision and Interpretation and Reporting

The interpretation and report for all bone densitometry services must be provided by a specialist or consultant physician.

Items 12306, 12312, 12315, 12321 and Items 12320 and 12322 (when performed using Dual Energy X-ray Absorptiometry) must be performed by a:

(a)     specialist or consultant physician; or

(b)     person who holds a State or Territory radiation license, and who is under the supervision of a specialist or consultant physician.

Items 12320 and 12322 (when performed using Quantitative Computed Tomography) must be performed by a:

(a)     specialist or consultant physician; or

(b)    a radiation licence holder who is registered as a medical radiation practitioner under a law of a State or Territory; and the specialist or consultant physician is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally. 

Referrals

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, 12312, 12315, 12320, 12321 and 12322.

For Item 12306 the referral should specify the indication for the test, namely:

(a)              1 or more fractures occurring after minimal trauma; or

(b)              monitoring of low bone mineral density proven by previous bone densitometry. 

For Item 12312 the referral should specify the indication for the test, namely:

(a)              prolonged glucocorticoid therapy;

(b)              conditions associated with excess glucocorticoid secretion;

(c)              male hypogonadism; or

(d)              female hypogonadism lasting more than 6 months before the age of 45. 

For Item 12315 the referral should specify the indication for the test, namely:

(a)              primary hyperparathyroidism;

(b)              chronic liver disease;

(c)              chronic renal disease;

(d)              proven malabsorptive disorders;

(e)              rheumatoid arthritis; or

(f)               conditions associated with thyroxine excess.

For Item 12312

(a)              '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

(b)              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.

Glucocorticoid therapy must be contemporaneous with the current scan. Patients no longer on steroids would not qualify for benefits. 

For Item 12312

(a)              Male hypogonadism is defined as serum testosterone levels below the age matched normal range.

(b)              Female hypogonadism is defined as serum oestrogen levels below the age matched normal range. 

For Item 12315

A malabsorptive disorder is defined as one or more of the following:

(a)              malabsorption of fat, defined as faecal fat estimated at greater than 18 gm per 72 hours on a normal fat diet; or

(b)              bowel disease with presumptive vitamin D malabsorption as indicated by a sub-normal circulating 25-hydroxyvitamin D level; or

(c)              histologically proven Coeliac disease.

Related Items: 12306 12312 12315 12320 12321 12322


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change