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J863
J863 – Scintimammography
OHIP Nuclear Medicine - IN VIVO Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Scintimammography is a nuclear medicine imaging procedure for unilateral or bilateral breast assessment. According to , the claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C. The technical component fee is $119.35 and the professional component is $45.55. This service is not eligible for payment unless at least one of the following conditions is met:
• The patient has a dense breast(s) and one or both of the following risk factors:
• a first degree relative with breast cancer diagnosed prior to age 50; or
• a first degree relative with breast cancer diagnosed over age 50 and patient is within 5 years of the age when the relative was diagnosed with breast cancer.
• Architectural distortion of the breasts due to prior breast surgery, radiotherapy, chemotherapy or the presence of breast prosthesis rendering mammography interpretation difficult.
• Malignant breast lesion when mammography is unable to exclude multifocal disease.
• Solitary lesion identified on mammography of greater than 1 cm.
Referral requiredFrom: Physician, OralMaxillofacialSurgeon
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record.
For the purpose of this provision, 'dense breast(s)' means (a) breast(s) occupied by over 75% fibroglandular tissue as noted on mammography.
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