J164 – Follicle monitoring studies
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Follicle monitoring studies via ultrasound. According to a note on page , for ovulation induction purposes, J162 and J138 are limited to one per cycle, and any additional ultrasounds may be claimed as J164. A commentary on the same page specifies that ultrasound services are not insured when rendered to support in-vitro fertilization services or artificial insemination services, as per Regulation 552 section 24(1) paragraph 23 and 29 under the Act.
When to Use
- Use J164 to bill for follicle monitoring ultrasounds that exceed the single-claim limit per cycle established for J162 and J138 during ovulation induction.
- Use J164 for medically necessary diagnostic pelvic ultrasounds that are distinct from the routine monitoring of ovulation induction cycles.
Common Pitfalls
- Billing J164 for ultrasounds related to in-vitro fertilization (IVF) or artificial insemination (AI) is strictly prohibited as these are uninsured services under Regulation 552.
- Claiming J164 in conjunction with G900 for residual urine measurement is a common rejection, as G900 is not eligible for payment when rendered with a pelvic or intracavitary ultrasound.
Billing Tips
- Ensure your documentation clearly distinguishes between medically necessary ovulation induction monitoring and excluded fertility services to withstand potential audits.
- Verify that the total number of claims for J162, J138, and J164 per cycle aligns with the clinical necessity documented in the patient's record.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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