J163 – Pelvic ultrasound - limited study - for other than pregnancy
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
J163 represents a limited ultrasound examination of the pelvis for indications other than pregnancy. As a diagnostic procedure, it includes both a technical component (H-fee) for performing the scan and a professional component (P-fee) for the interpretation and report. See commentary on page for services that are not insured, such as those to support in-vitro fertilization or artificial insemination services. It is not payable with G900 (residual urine measurement by ultrasound).
When to Use
- Use J163 for a focused pelvic ultrasound when investigating non-obstetric pathology such as suspected ovarian cysts, fibroids, or pelvic pain in a non-pregnant patient.
- Select J163 when the clinical question is limited in scope, as opposed to a comprehensive pelvic ultrasound which would require a different billing code.
Common Pitfalls
- Billing J163 alongside G900 will result in a rejection, as these services are mutually exclusive for the same patient encounter.
- Attempting to bill J163 for pregnancy-related indications is a common audit trigger; ensure the indication is strictly non-obstetric.
- Submitting J163 for services related to in-vitro fertilization or artificial insemination is non-insured and will lead to claim recovery.
Billing Tips
- Ensure your documentation clearly distinguishes the limited nature of the study to justify the use of J163 over more comprehensive diagnostic codes.
- If the patient is under 16 years of age, remember to apply the appropriate age-based fee premium to the J163 claim to ensure accurate reimbursement.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The physician submitting a claim for the technical component must have the necessary training and experience to personally render the technical component of the service.
The physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.