J127 – Scan B-mode (per breast)
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
J127 represents a B-mode diagnostic ultrasound scan of the breast, and it is payable on a per-breast basis. This service is comprised of two distinct components: a professional component (P-fee: $13.10) for the physician's interpretation and report, and a technical component (H-fee: $23.70) for the use of equipment and staff to perform the scan. Payment for these components is subject to specific rules outlined in the Schedule, particularly concerning the location of service. For detailed rules on billing technical and professional components, refer to of the Schedule of Benefits.
When to Use
- Use J127 for a diagnostic B-mode ultrasound of the breast when a formal, written report is generated for a patient referred by a physician or nurse practitioner.
- Bill J127 on a per-breast basis; if both breasts are scanned, you must bill J127 twice, indicating the appropriate site (left/right) for each claim.
Common Pitfalls
- Billing the technical component (H-fee) for hospital in-patients or patients admitted within 24 hours of the scan is a common cause of rejection; ensure only the professional component is claimed in these settings.
- Attempting to bill J127 without a valid referral from a physician or nurse practitioner will result in audit recovery, as the referral requirement is mandatory under GP16 and GP111.
- Claiming J127 for screening purposes rather than diagnostic investigation can lead to rejection if the clinical indication does not support a diagnostic ultrasound.
Billing Tips
- When performing urgent, non-elective diagnostic breast ultrasounds in a hospital setting, ensure you pair the professional component of J127 with the correct special visit premium (C108, C109, or C110) to maximize reimbursement.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
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