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J897
J897 – Repeat diagnostic study - Level 1
OHIP Diagnostic and Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A “Repeat diagnostic study” means an overnight diagnostic sleep study rendered:
• a. for the purpose of obtaining a second opinion at a different facility than the facility where the preceding study was rendered, provided that the following conditions are met:
• i. prior to the repeat diagnostic study, the patient has been assessed by a physician who practices sleep medicine at the different facility,
• ii. where the previous study was rendered at an ICHSC and the repeat diagnostic study is rendered at a different ICHSC (the “different facility”) than the ICHSC where the preceding study was rendered (the “first facility”), neither the owner nor the operator of the different facility is, at the time the repeat study is rendered, an associate of the owner or operator of the first facility, where “associate” has the same meaning as in the Integrated Community Health Services Centres Act, 2023; or
• b. for one or more of the following purposes, after pre-study assessment by a physician practicing sleep medicine:
• i. re-evaluation of a previous negative or inconclusive diagnostic sleep study as indicated by persistent or progressive symptoms;
• ii. re-evaluation, other than primarily for Positive Airway Pressure therapy (PAP) adjustment, of patients previously diagnosed with a primary sleep disorder in which there has been symptom development suggesting another co-morbid sleep disorder; or
• iii. re-evaluation of patients with an established diagnosis of a sleep disorder other than a sleep related breathing disorder who have significant symptom progression or non-response to therapy.
Referral requiredFrom: Physician, NursePractitionerPre-authorization required
Payment Rule 1: Repeat diagnostic studies are limited to one per patient, per facility, per 12-month period except where prior approval has been given.
Payment Rule 2: Repeat diagnostic studies performed in the same facility that performed the initial diagnostic study are not eligible for payment in the 12 month period following an initial diagnostic study except where prior approval has been given.
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