Medicare Eligibility Considerations
The Government uses rules to determine if rebates offered by Medicare and the Department of Veterans Affairs can be accessed by patients. To be eligible for such a rebate patients must meet one of the following criteria, and such criteria must be indicated on the referral, ideally with the relevant Medicare item Number.
Summary of Medicare Eligible Bone Density Examinations effective 1 Nov 2017:
Item Number 12306
One service only in a 24 month period if performed for:
- Confirmation of a presumptive diagnosis of low bone mineral density made on the basis of one or more factures occurring after minimal trauma. Can only be used once for each fracture; or
- Monitoring of osteoporosis proven by previous bone densitometry at least 12 months previously;
- Scan at least 2 years prior with Z score of -1.50 or lower, or T score of -2.50 or lower.
Item Number 12312
One service only in a 12 month period if performed for:
- Prolonged and current glucocorticord therapy (as per dose limits outlined in the MBS);
- Conditions associated with excess glucorticoid secretion;
- Male hypogonadsim; or
- Female hypogonadism lasting more than 6 months before the age of 45 years.
Item Number 12315
One service only in a 24 month period if performed for diagnosis and monitoring of bone loss associated with one or more of the following:
- Primary hyperparathyroidism;
- Chronic liver disease;
- Chronic renal disease;
- Proven malabsorptive disorders (e.g. Coeliac or Crohn’s disease);
- Rheumatoid arthritis; or
- Conditions associated with thyroxine excess.
Item Number 12321
One service only in a 12 month period
- If performed 12 months following a significant change in therapy for established low bone mineral density. (Change in class of drugs rather than change in dose regime, or confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures occurring after minimal trauma.)
Patients over 70 yrs:
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 the measurement of bone mineral density, in a patient aged 70 years or over if:
Item Number 12320
- (a) the patient has not had previous bone densitometry testing; or
- (b) the patient has bone mineral density as measured by a t‑score of ‑1.5 or above; other than a service associated with a service to which item 12306, 12312, 12315, 12321 or 12322 applies For any particular patient, once only in a 5 year period
Item Number 12322
- (a) the patient is 70 years of age or over; and
- (b) the patient has bone mineral density as measured by a t‑score of less than between ‑1.5 or above ‑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
Routine Bone Mineral Density Measurement
Includes all other indications. No Medicare Benefit is applicable. Our normal fee applies.
Please contact us if you require further information. Please note that information regarding Medicare Eligibility is determined by the Federal Government. As such, this information may change. Please contact your local NCRG branch for current information.