X001 – Skull - four views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service consisting of four X-ray views of the skull. This service is listed with a technical component fee (H) of $29.90 and a professional component fee (P) of $13.25. The professional component covers the interpretation of the images. Dental x-rays of the teeth are not an insured benefit.
When to Use
- Use X001 when a patient requires a formal four-view radiographic assessment of the skull for trauma or suspected pathology, as opposed to limited views like X003.
- Use this code for diagnostic imaging where the clinical documentation explicitly supports the necessity of all four standard views to rule out fractures or intracranial abnormalities.
Common Pitfalls
- Billing X001 for dental imaging or intraoral X-rays, which are explicitly excluded as non-insured benefits under the Schedule of Benefits.
- Submitting the technical component (suffix B) for an inpatient or a patient admitted to the hospital within 24 hours of the service, which is a violation of the technical component payment rules.
- Failing to differentiate between the professional component (suffix C) and the technical component (suffix B) in the claim submission, leading to automatic rejections.
Billing Tips
- Ensure the professional component (suffix C) is billed by the interpreting radiologist, while the technical component (suffix B) is only claimed when the facility equipment is used for an outpatient not subsequently admitted.
- If the service is performed as part of a major trauma assessment, ensure the Injury Severity Score (ISS) is documented in the chart to support the addition of the E420 trauma premium.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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.
Claims Submission: For diagnostic services with both technical and professional components, the claim for the technical component is submitted using the fee schedule code with suffix B, and the claim for the professional component is submitted using the fee schedule code with suffix C.
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