J862 – Ocular tumour localization
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Ocular tumour localization (J862) is a nuclear medicine imaging procedure listed in the Schedule under Miscellaneous In Vivo studies. As per page , the service is divided into two components for billing purposes, each with its own fee: - Technical Component (H): Fee is $75.60. This is claimed using J862B. As per , the technical component is not eligible for payment if the service is rendered to a hospital in-patient, or to a patient who attends a hospital and is admitted within 24 hours of receiving the diagnostic service for the same condition. Furthermore, the technical component rendered outside of a hospital is not eligible for payment. - Professional Component (P): Fee is $54.90. This is claimed using J862C and represents the physician's work in interpreting the scan and providing a report. The physician submitting a claim for the technical component is responsible for the complete quality assurance process, including data acquisition, reporting, and record keeping, and must maintain documentation of this process as per .
When to Use
- Use J862C for the professional interpretation and reporting of ocular tumour localization scans performed in a clinical setting.
- Use J862B for the technical component when the procedure is performed in a non-hospital facility that meets all quality assurance and data acquisition standards.
- Use J862B and J862C together only when the billing physician is responsible for both the technical quality assurance and the professional interpretation in an eligible non-hospital environment.
Common Pitfalls
- Submitting J862B for services rendered to hospital in-patients or patients admitted within 24 hours of the scan will result in automatic rejection.
- Claiming the technical component (J862B) for services performed within a hospital setting is strictly prohibited and constitutes a billing error.
- Failing to maintain specific, auditable documentation of the quality assurance process for J862B risks full recovery of the technical fee during an OHIP audit.
Billing Tips
- Ensure that the professional component (J862C) is always supported by a formal, dated report in the patient record to justify the interpretation fee.
- When providing urgent, non-elective hospital services, ensure you select the correct special visit premium (C102-C104) and corresponding 'first person seen' code (C108-C110) to avoid bundling rejections.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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