J125 – Chest masses, pleural effusion - A & B-mode
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Diagnostic ultrasound of the thorax, using both A-mode and B-mode imaging, to investigate and evaluate chest masses or pleural effusions. This service is divided into a technical component (H) and a professional component (P). Per , the technical fee is $48.75 and the professional fee is $24.55. The claim for the technical component must be submitted using the fee code with suffix B (J125B), and the claim for the professional component must be submitted with suffix C (J125C).
Note: For echocardiography of the heart, refer to the listings in the Diagnostic and Therapeutic Procedures section of the Schedule of Benefits.
When to Use
- Use J125 for the diagnostic evaluation of a suspected pleural effusion where A-mode and B-mode imaging are both required for clinical assessment.
- Use J125 to characterize chest wall or pleural-based masses that cannot be adequately assessed via standard chest radiography.
Common Pitfalls
- Failure to bill the technical (J125B) and professional (J125C) components as separate line items will result in an automatic rejection.
- Billing J125 for cardiac imaging is a common error; echocardiography must be billed under the specific cardiac diagnostic codes in the Schedule of Benefits.
- Submitting J125 without a valid referral from an authorized provider (Physician, NP, or Surgeon) is a frequent cause of audit recovery.
Billing Tips
- Ensure the technical component (J125B) is supported by documentation confirming the quality assurance process, including data acquisition and record keeping, as required by the MOH.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate the above upon request by the MOH.
Heart - Echocardiography - see listings in Diagnostic and Therapeutic Procedures.
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