J157 – Diagnostic ultrasound - Gestational age for Maternal Serum Screening Program
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
This service is an ultrasound performed before 16 weeks gestation for the purpose of determining gestational age for the Maternal Serum Screening Program. It consists of two components: - Technical Component (H): This component covers the use of the equipment, supplies, and personnel for the procedure. The technical component is not eligible for payment if the service is rendered outside of a hospital or an Integrated Community Health Services Centre (ICHSC) (formerly IHF). See . - Professional Component (P): This component covers the physician's service of interpreting the ultrasound images and providing a report. This service is insured when referred by a physician, nurse practitioner, midwife, or aboriginal midwife ().
When to Use
- Use J157 specifically for dating scans requested for the Maternal Serum Screening (MSS) program before 16 weeks gestation.
- Use this code when the primary clinical intent is gestational age assessment for screening, rather than a general diagnostic scan like J159 or J160.
Common Pitfalls
- Billing the technical component (H) for scans performed in a private physician office will result in automatic rejection, as this component is only payable in hospitals or ICHSCs.
- Submitting J157 for dating scans performed at or after 16 weeks gestation is an audit risk; these should be billed under general diagnostic ultrasound codes like J159.
- Failing to include the referring provider's information on the claim will trigger a rejection, as a formal referral is a mandatory requirement for this service.
Billing Tips
- Ensure you bill the professional component (P) separately from the technical component (H) to reflect the physician's interpretation and reporting duties.
- Verify the gestational age is strictly under 16 weeks at the time of the scan to ensure compliance with the specific criteria for the MSS program.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
Before 16 weeks gestation
Female
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