J105 – Ultrasound of face and/or neck, excluding vascular study
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Ultrasound imaging of the face and/or neck, excluding vascular studies. The fee is split into a technical component (H fee: $47.30) and a professional component (P fee: $23.70). Per the Schedule, this code is not eligible for payment when rendered for ultrasound imaging of the sinus(es).
When to Use
- Use J105 for soft tissue neck ultrasounds, such as evaluating a palpable thyroid nodule or a non-vascular neck mass.
- Use J105 for imaging superficial facial masses or cysts that do not involve vascular mapping or Doppler flow studies.
- Use J105 for assessing lymphadenopathy in the neck when the clinical intent is to characterize morphology rather than vascularity.
Common Pitfalls
- Billing J105 for sinus imaging will result in an automatic rejection, as this is explicitly excluded by the Schedule.
- Attempting to bill J105 for vascular studies is incorrect; use appropriate vascular ultrasound codes instead to avoid audit flags for miscoding.
- Failing to account for the technical component (H fee) restriction when a patient is admitted to the hospital within 24 hours of the outpatient ultrasound.
Billing Tips
- Ensure the referral explicitly states the clinical indication for the face or neck, as J105 requires a valid referral from a physician, NP, or oral maxillofacial surgeon.
- When performing this in a hospital setting, verify if the patient meets the 24-hour admission rule, as the technical component (H fee) is not payable if the patient is admitted for the same condition.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
J105 is not eligible for payment when rendered for ultrasound imaging of the sinus(es).
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