J162 – Pelvic ultrasound - complete
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A complete diagnostic ultrasound of the pelvis. Note: - For ovulation induction purposes, the limit is one per cycle. Additional ultrasounds may be claimed as J164. - Residual urine measurement by ultrasound (G900) is not eligible for payment when rendered with an ultrasound of the pelvis. Commentary: - Ultrasound services are not insured when rendered to support in-vitro fertilization services or artificial insemination services.
When to Use
- Use for a complete diagnostic pelvic ultrasound assessment of the uterus, ovaries, and adnexa for clinical indications like pelvic pain, abnormal uterine bleeding, or suspected adnexal masses.
- Use as the primary billing code for the initial pelvic ultrasound in an ovulation induction cycle, as it is limited to one per cycle.
Common Pitfalls
- Do not bill G900 for residual urine measurement on the same day as J162, as the Ministry considers this an ineligible duplicate service.
- Avoid billing J162 for ultrasounds performed specifically for IVF or artificial insemination, as these are explicitly excluded from OHIP coverage.
- Do not use J162 for follow-up ultrasounds within the same ovulation induction cycle; these must be billed under J164.
Billing Tips
- Ensure the referral source is documented, as J162 requires a valid referral from a physician, nurse practitioner, midwife, or oral maxillofacial surgeon.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The physician must have the necessary training and experience to personally render the technical component of the service.
The physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
For ovulation induction purposes, the limit is one per cycle. Additional ultrasounds may be claimed as J164.
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