What is OHIP billing code J199?

J199 is "Penile Doppler scan", an OHIP Cardio-Thoracic Surgery code from the Ontario Schedule of Benefits (Physician Services).

How much does J199 pay?

The current OHIP fee for J199 is $0.00, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill J199 to OHIP?

J199 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates J199 claims against the Schedule of Benefits rules before submission.

All codes

J199

J199 – Penile Doppler scan

OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits

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A Doppler scan of the penis. As per the note on page :, Penile Doppler is only insured for the following indications: - priapism; - trauma; - revascularization; - primary erectile dysfunction; or - failure of both oral and injectable therapy for erectile dysfunction.

When to Use

Use J199 when investigating suspected vascular etiology in patients who have documented failure of both oral PDE5 inhibitors and intracavernosal injection therapy.
Use J199 for acute assessment of priapism to differentiate between ischemic and non-ischemic subtypes.
Use J199 for post-operative assessment following penile revascularization surgery to confirm graft patency.

Common Pitfalls

Billing J199 for routine erectile dysfunction without documented failure of both oral and injectable therapies will result in automatic rejection or clawback upon audit.
Submitting J199 for cosmetic or enhancement-related concerns is strictly prohibited as it falls outside the five insured clinical indications.
Failure to include the specific diagnostic indication in the referral or clinical notes will lead to claim rejection, as the Ministry requires proof of medical necessity for this specific procedure.

Billing Tips

Ensure the referring physician explicitly documents the failure of both oral and injectable therapies in the referral to satisfy the specific criteria listed on page G9.
Do not bill the technical component (H) if the scan is performed within a hospital setting, as this is bundled into the hospital's global budget.

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Provider Fee$0.00

Surgical Assistant Fee$7.25

Anaesthetist Fee$7.80

Non-Anaesthetist Fee$7.80

Effective: April 1, 2025

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