What is OHIP billing code J005?

J005 is "Dacrocystogram", an OHIP Cardio-Thoracic Surgery code from the Ontario Schedule of Benefits (Physician Services).

How much does J005 pay?

The current OHIP fee for J005 is $45.40, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill J005 to OHIP?

J005 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates J005 claims against the Schedule of Benefits rules before submission.

What codes are related to J005?

Codes related to J005 in the Schedule of Benefits include J001, J024, J044, J002, J043, J003, J042, J050.

All codes

J005

J005 – Dacrocystogram

OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits

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A dacrocystogram is a radiological procedure used to examine the lacrimal apparatus (tear ducts). This involves the injection of a contrast medium into the nasolacrimal duct system, followed by radiographic imaging to assess for blockages or other abnormalities.

When to Use

Use J005 when performing a formal dacrocystogram to visualize the nasolacrimal duct system via contrast injection and radiographic imaging.
Use this code for diagnostic assessment of epiphora or suspected nasolacrimal duct obstruction when imaging is the primary objective.

Common Pitfalls

Do not bill J005 in conjunction with a simple lacrimal duct probing or irrigation if no radiographic imaging is performed, as these are distinct procedures.
Avoid billing J005 as a substitute for surgical procedures like J006 (Dacrocystorhinostomy), as J005 is strictly diagnostic and does not cover therapeutic intervention.
Ensure the procedure is not billed as a routine office visit; J005 is a clinical procedure associated with diagnostic radiology and requires specific procedural documentation.

Billing Tips

Apply the appropriate age-based premium (e.g., AGE_PREMIUM_LT16Y) if the patient meets the specific age criteria, as J005 is classified as a surgical procedure for premium eligibility.
If the procedure is performed on an urgent or non-elective basis after hours, ensure you append the E409 or E410 premium to the J005 claim to capture the 50% or 75% increase respectively.

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Provider Fee$45.40

Anaesthetist Fee$92.94

Non-Anaesthetist Fee$92.94

Effective: April 1, 2025

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