J159 – Diagnostic ultrasound - pregnancy - complete - on or after 16 weeks gestation
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A complete pregnancy ultrasound performed on or after 16 weeks of gestation. This service is intended for a normal pregnancy. The service has separate fee components: a technical component (H) and a professional component (P). Per , the technical component is claimed with suffix B and the professional component is claimed with suffix C. Payment Rule: As per , ultrasound services listed under the headings 'Abdomen and Retroperitoneum' or 'Pelvis' or 'Pregnancy' (including J159) rendered on the same day to the same patient by any physician as J168 are not eligible for payment.
When to Use
- Use J159 for a routine anatomical survey or fetal growth assessment in a normal pregnancy at or beyond 16 weeks gestation.
- Select J159 when performing a complete pregnancy ultrasound that does not meet the specific criteria for a limited scan (J160) or a biophysical profile (J166).
Common Pitfalls
- Billing J159 on the same day as J168 will result in an automatic rejection, as both are restricted under the same diagnostic ultrasound category.
- Claiming the technical component (J159B) for a patient who is a hospital inpatient or admitted within 24 hours of the service is a violation of the technical component payment rules.
- Failing to split the claim into J159B and J159C components will lead to incorrect payment processing or rejection.
Billing Tips
- Ensure the referral source is documented as a Physician, Nurse Practitioner, or Midwife to satisfy the mandatory referral requirement for diagnostic ultrasound services.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
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