J055 – Percutaneous gastrostomy
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
This service covers the performance of a percutaneous gastrostomy. As a procedural service, it includes the common and specific elements outlined in the - of the Schedule of Benefits. These elements include but are not limited to: - Preparing the patient for the procedure. - Performing the percutaneous gastrostomy. - Making arrangements for any related assessments, procedures, or therapy. - Post-procedure monitoring and follow-up care. - Discussion with the patient or their representative regarding the procedure.
When to Use
- Use J055 specifically for the initial placement of a percutaneous gastrostomy tube performed under radiological guidance.
- Use J055 when the procedure is performed as a standalone clinical procedure, distinct from surgical gastrostomy codes which fall under different fee schedules.
Common Pitfalls
- Billing J055 in conjunction with a consultation or assessment code on the same day is often rejected; the procedure fee is intended to be global for the encounter.
- Failure to document the specific radiological guidance used will lead to audit recovery, as J055 is categorized under clinical procedures associated with diagnostic radiology.
Billing Tips
- If the procedure is performed after hours, ensure you append E409 or E410, as J055 is explicitly listed as an eligible code for these procedural premiums.
- Always verify if the patient qualifies for the age-based premiums (e.g., AGE_PREMIUM_UNDER_16Y) as these are calculated as a percentage increase on the base J055 fee.
Effective: April 1, 2026
E. Clinical Procedures associated with Diagnostic Radiological Examinations
CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS
Procedure
Clinical Procedures associated with Diagnostic Radiological Examinations
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.