J149 – Ultrasonic guidance of biopsy, aspiration, amniocentesis or drainage procedures
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Ultrasonic guidance for procedures such as biopsy, aspiration, amniocentesis, or drainage where both the professional and technical components are provided by one physician. This service is comprised of a professional (P) component and a technical (H) component. Professional Component (P) Specific Elements: - A. Providing clinical supervision and quality control of all elements of the technical component of the procedure. - B. Providing ultrasonic guidance for the physician performing the associated procedure. - C. Where appropriate, post-procedure monitoring, including intervening except where this constitutes a separately billable service. - D. Discussion with, and providing information and advice to the patient or patient's representative, whether by telephone of otherwise, on matters related to the service. - E. Providing premises for any aspect(s) of A and D that is(are) performed at a place other than the place in which the procedure is performed. Technical Component (H) Specific Elements: - A. Preparing the patient for the procedure. - B. Assisting at the performance of the procedure. - C. Making arrangements for follow-up care. - D. Discussion with, and providing information and advice to the patient or patient's representative, whether by telephone or otherwise, on matters related to the service. - E. Providing premises, equipment, supplies and personnel for all specific elements of the technical and professional components except for the premises for any aspect(s) of A and D of the professional component that is(are) not performed at the place in which the procedure is performed. This service also includes the common elements of insured services as outlined in the General Preamble (-).
When to Use
- Use J149 when you perform both the professional supervision and provide the technical equipment/facility for an ultrasound-guided biopsy, aspiration, or drainage.
- Use this code for amniocentesis procedures where you are personally providing the ultrasound guidance and the technical resources in your own facility.
Common Pitfalls
- Attempting to bill J138 or J161 in addition to J149 on the same day will result in a rejection or zero payment as they are explicitly restricted.
- Failing to submit the claim with the correct suffix (C for professional, B for technical) will lead to processing errors or incorrect payment calculations.
- Billing the full technical fee for hospital-based procedures; remember that J149 technical component (suffix B) is payable at 86.10% when performed in a hospital setting.
Billing Tips
- Ensure your documentation clearly delineates the professional supervision (suffix C) from the technical provision (suffix B) to satisfy audit requirements for both components.
- Always verify that the referral source is valid per GP111 before performing the procedure to avoid non-insured service denials.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Procedure
Diagnostic Ultrasound, Diagnostic and Therapeutic Procedures
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.
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