How do I fix OHIP error code X4?

Check the patient's BMD history and the code you billed. If the patient had a patient-specific risk factor (secondary osteoporosis risk, a new fragility fracture or rapid bone loss), X236 or X237 may have been the right code. Keep the documentation; the Ministry may ask for it. If you believe the payment is wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details.

When shouldn't I resubmit a X4 claim?

You disagree with how a claim already on the RA was paid. Use an RAI, not a new claim.

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Error code

X4 — Only 1 bone density (BMD) test allowed within 36 months for low-risk patients

Q: What does OHIP error code X4 mean?

OHIP refused this bone density (BMD) test because one was already paid in the last 36 months. Check the patient's BMD history.

Bone density test too soon

The bone density test was refused because the patient already had one within the 36-month limit for this risk group.

What to do: Check the patient's bone density history; if a patient-specific risk factor applied, X236 or X237 may have been the right code.

Code: X4
Description: Only 1 bone density (BMD) test allowed within 36 months for low-risk patients

Explanation

Updated October 26, 2026

OHIP refused this bone density (BMD) test because one was already paid in the last 36 months. Check the patient's BMD history.

What it means

Code X4 means the Ministry allows only one bone mineral density (BMD) test within a 36-month period for a patient in this risk group, and an earlier BMD test falls inside that period.

The current Schedule (D16–D17) sets these limits: baseline test (X145, X146) once per lifetime; non-high-risk subsequent test (X142, X148) once every 60 months; high-risk or therapy-monitoring test (X149, X155) once every 36 months; and a test for patient-specific risk factors (X236, X237) at most once every 12 months, only when the clinical situation needs testing more often than every 36 months. The Ministry's wording of X4 ("low risk patient") predates the current "high-risk / non-high-risk" wording.

Common causes

A repeat BMD within 36 months of the patient's last BMD test, at any facility

How to fix it

Check the patient's BMD history and the code you billed.
If the patient had a patient-specific risk factor (secondary osteoporosis risk, a new fragility fracture or rapid bone loss), X236 or X237 may have been the right code. Keep the documentation; the Ministry may ask for it.
If you believe the payment is wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details.

Don't resubmit if

You disagree with how a claim already on the RA was paid. Use an RAI, not a new claim.

How APEX handles it

APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing

Related codes: X5, X6