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If you have had your BMD test cancelled in the past month, please reach out to your healthcare provider to see if you are eligible to have your test rescheduled.

If you recently had a BMD test, and your next test is booked for 3 years later, please reach out to your healthcare provider to see if you may need to have your test performed earlier.

The Ministry of Health issued the following on April 29, 2026:

Re: Interpretation and Billing Clarification for Bone Mineral Density Services

The Ministry of Health (the ministry) and the Ontario Medical Association (OMA) have been working together to implement physician compensation changes agreed to under the 2024 Physician Services Agreement (PSA). As part of this work, on April 1, 2026, permanent fee code adjustments were made to the Schedule of Benefits for Physician Services under Regulation 552 of the Health Insurance Act and the Schedule of Facility Costs for Integrated Community Health Services Centres under the Integrated Community Health Services Centres Act.

The ministry has heard concerns from physicians related to changes made to Bone Mineral Density (BMD) testing in Ontario, as part of the April 1, 2026, Schedule changes. We thank physicians for their outreach, as this has identified the need to provide additional information and clarification regarding eligibility for insured BMD testing.

As stated in the Schedules, baseline BMD testing is permitted once per lifetime in accordance with clinical guideline recommendations for screening, or earlier in clinical scenarios that fall outside the scope of guidelines. For the purposes of subsequent testing, clinical guidelines provide recommendations but there are also clinical scenarios that fall outside the scope of guidelines. To support appropriate interpretation and billing, an overview of key clinical scenarios is provided below:

A. Subsequent BMD testing for patients over age 50

For patients over age 50, subsequent BMD after baseline testing should be performed at intervals of once every three years or longer according to the fracture risk assessment using FRAX (or an equivalent major osteoporotic fracture risk tool) or as relevant to osteoporosis pharmacotherapy initiation and management, in alignment with the current Osteoporosis Canada Clinical Practice Guideline for the Management of Osteoporosis in Canada. Claims for these services should be submitted at the frequencies that are clinically appropriate, using existing fee codes (e.g. X142/X148 or X149/X155). This applies to routine subsequent screening or therapy monitoring, but may not apply in situations where a patient develops secondary causes, new fracture or other risk factor for rapid bone loss (see item C below).

B. BMD testing for patients under age 50

BMD services for patients under 50 years of age, including pediatric patients, continue to be eligible for payment. As outlined in commentary #3 of the Schedules, the specific conditions in the guidelines do not apply to this population, and claims should continue to be submitted for these services at the frequencies that are clinically appropriate, as was the case prior to April 2026, using existing fee codes (e.g. X142/X148, X149/X155 or X237/X236).

C. Diagnostic or medically necessary BMD testing (all ages)

BMD testing for diagnostic purposes, or where the results of the BMD test are required to inform therapeutic patient management—regardless of age—should be performed at frequencies based on generally accepted standards of care, and may be required more frequently than once every three years. This includes clinical scenarios beyond Hypercortisolism/Cushing’s syndrome or receiving high-dose glucocorticoid therapy > 20 mg Prednisone equivalent per day. Clinical expertise should inform appropriate testing frequency, supported by medical documentation. Eligibility for these BMD tests are authorized under independent consideration by the ministry, but does not require manual review. Physicians should continue to order medically necessary BMD services based on clinical judgment and generally accepted standards of care. Claims for these services should be submitted using X237 or X236, depending on the number of sites measured. Referring physicians must document the clinical circumstance requiring more frequent testing in the patient’s permanent medical record.

Please note that the above clarification for codes X237 and X236 applies to all services effective as of April 1, 2026. If claims were previously rejected that fall within the scope outlined above, they can be resubmitted.

The ministry and OMA, through the bilateral Physician Services Committee (PPC), have been engaging with clinical experts to inform future Schedule changes to ensure the clarification provided above is reflected in the next version of the Schedules.

We want to thank physicians for their expertise, feedback, and continued dedication to patient care.

View the official letter from the Ministry of Health here