Clarifications to the Schedule of Benefits for Bone Mineral Density Measurements, Frontal Sinusotomy and Denervation services effective April 1, 2026.

To: All Physicians, Integrated Community Health Services Centres
Category: Physician Services, Community surgical and diagnostic centres
Written by: Provider Services Branch and Physician and Provider Services Division
Date issued: August 18, 2026
Bulletin Number: 260804

Background

The Ministry of Health and the Ontario Medical Association have been working together to implement the 2024 Physician Services Agreement.

Following recommendations from the Physician Payment Committee, clarifications to the Schedule of Benefits for Physician Services (the schedule) have been made, effective April 1, 2026.

Bone Mineral Density (BMD) measurements

Baseline BMD testing is permitted once per lifetime, after age 50, in accordance with clinical guideline recommendations for screening, or earlier in clinical scenarios that fall outside the scope of guidelines.

For patients over age 50, subsequent BMD after baseline testing should be performed at intervals of:

  • once every 3 or more years for therapy monitoring and for high-risk patients, as defined in the schedule
  • once every 5 or more years for non-high-risk patients
  • once every 12-36 months for patients with the following risk factors:
    • secondary osteoporosis consistent with Canadian clinical practice guidelines in place at the time of the service
    • a new fragility fracture
    • a risk factor for rapid bone loss

For patients under 50, BMD testing is not routine practice unless specific comorbidities are present, or unless fragility fractures have occurred. In these cases, BMD services are eligible for payment at the frequencies that are clinically appropriate using the same fee code listings (12+ months, 36+ months, 60+ months).

Please refer to the schedule to review the complete list of payment rules and other conditions for payment.

Frontal Sinusotomy

The descriptors of Z318, M050 and M052 have been updated to align with Draf classifications, as follows:

  • Z318 Trephine or endoscopic frontal sinusotomy (e.g., Draf I or Draf IIA)
  • M050 Frontal sinusotomy (e.g., Draf IIB or Draf IIC), unilateral
  • M052 Median frontal sinusotomy (e.g., Draf III / Modified Lothrop)

Denervation services

In addition to the earlier clarification that denervation/decompression of peripheral nerves is insured under existing fee codes listed on pages X12-X13 of the schedule when performed by open surgical exposure, the descriptors of R426 and R427 have been updated to align with peripheral nerve fee listings, as follows:

  • R426 Denervation - elbow, by open surgical exposure
  • R426 Denervation of knee, by open surgical exposure
  • R427 Denervation of hip, by open surgical exposure

Keywords/Tags

Physician Services Agreement; PSA; Physician Payment Committee; PPC; Bone Mineral Density; BMD; Frontal Sinusotomy; Draf; Denervation

Contact information

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