X005 – Nose - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiological examination of the nose involving two views. This service is listed in the Diagnostic Radiology section under Head and Neck. The fee is comprised of a professional component (P) and a technical component (H) which are claimed separately. As per , dental x-rays of the teeth are not an insured benefit.
When to Use
- Use X005 for a standard two-view radiographic assessment of the nasal bones following trauma to rule out fracture.
- Use this code when clinical suspicion of nasal bone pathology necessitates imaging, provided the request originates from an authorized provider.
Common Pitfalls
- Submitting X005 for dental or periodontal imaging, which is explicitly excluded from OHIP coverage under Section D5.
- Failing to split the claim into the professional component (suffix C) and the technical component (suffix B), leading to automatic rejection.
- Bypassing the referral requirement; X005 must be requested by a physician, nurse practitioner, or oral maxillofacial surgeon to be eligible for payment.
Billing Tips
- Ensure the technical component (suffix B) is claimed by the facility or physician responsible for the quality assurance process as per GP11:25.
- When providing urgent, non-elective diagnostic services in a hospital setting after hours, ensure you select the appropriate Special Visit Premium (C102-C110) rather than attempting to bundle these into the base code.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The physician submitting a claim for the technical component is responsible for the complete quality assurance process and must maintain documentation describing the process by which the physician monitors quality assurance in accordance with professional standards. <Source: :25>
All insured services must be documented in appropriate records that establish the service was provided, the service claimed is the service that was rendered, and the service was medically necessary. <Source: :22>
Dental x-rays of the teeth are not an insured benefit. <Source: :353>
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.