J161 – Intracavitary ultrasound - limited - for other than pregnancy
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A limited intracavitary ultrasound for indications other than pregnancy. This service is comprised of a technical component (H fee: $32.10) and a professional component (P fee: $16.25). The technical component covers the performance of the scan, and the professional component covers the physician's interpretation and report.
As per , 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 this upon request by the MOH.
The technical component (H fee) is not eligible for payment if rendered outside of a licensed facility (e.g., an Independent Health Facility - IHF). For services rendered in a hospital, the technical costs are covered by the hospital's budget, and only the professional component (P fee) is payable to the physician.
When to Use
- Use J161 for a limited transvaginal ultrasound to assess pelvic pathology such as ovarian cysts or endometrial thickness when pregnancy has been ruled out.
- Use J161 when performing a focused intracavitary scan for non-obstetrical indications that does not meet the comprehensive requirements of a full pelvic ultrasound.
Common Pitfalls
- Billing the technical component (H fee) for scans performed in a hospital setting, which is strictly prohibited as the hospital covers these costs.
- Attempting to bill G900 for residual urine measurement on the same day as J161, which will result in an automatic rejection.
- Submitting J161 alongside J165 for the same patient encounter, as J161 is considered an inclusive service and will be paid at nil.
Billing Tips
- Ensure you only claim the professional component (P fee) when working within a hospital facility to avoid audit triggers related to technical component billing.
- If performing a transvaginal sonohysterography, bill J165 instead of J161, as J161 is not payable when rendered in conjunction with that procedure.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
1. For residual urine measurement by ultrasound (G900), see Diagnostic and Therapeutic Procedures, section J, Urology.
2. Residual urine measurement by ultrasound (G900) is not eligible for payment when rendered with an ultrasound of the pelvis or intracavitary ultrasound.
Note for J165: J138 and J161 rendered in conjunction with J165 are insured services payable at nil.
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