X006 – Mandible - three views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Radiological examination of the mandible consisting of three views. This service can be for a unilateral or bilateral examination. This service has two fee components: a professional component (P fee) and a technical component (H fee). The technical component is only payable for services rendered in a hospital. See eligibility rules for more details.
When to Use
- Use X006 when a formal three-view radiological series of the mandible is required for trauma or pathology, distinguishing it from the single-view or limited-view assessments often captured under X012.
- Select X006 for both unilateral and bilateral mandibular imaging, as the code description explicitly covers both scenarios without requiring additional modifiers.
Common Pitfalls
- Billing X006 for dental-specific imaging is a common rejection, as dental x-rays of the teeth are explicitly excluded from OHIP coverage.
- Attempting to claim the technical (H) component for services performed in a private clinic or office setting will result in rejection, as this component is strictly reserved for hospital-based services.
- Failing to maintain the required quality assurance documentation for the technical component is a significant audit risk that can lead to clawbacks of the H-fee portion.
Billing Tips
- Ensure the referral source is limited to a physician, nurse practitioner, or oral/maxillofacial surgeon to comply with the specific referral requirements for this diagnostic code.
- When providing urgent, non-elective interpretations in a hospital setting, verify that you are not billing X006 alongside other special visit premiums (like C109 or C110) for the same patient encounter, as these are mutually exclusive.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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.
Dental x-rays of the teeth are not an insured benefit. (:)
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