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X012
X012 – Mandible - four or more views
OHIP Diagnostic Radiology Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service under the Head and Neck category, consisting of four or more views of the mandible. The Schedule of Benefits lists a technical component (H-fee) and a professional component (P-fee) for this service. The professional component covers the physician's interpretation of the images, while the technical component covers the cost of the facility, equipment, and staff to perform the X-ray. Per , dental x-rays of the teeth are not an insured benefit.
Referral requiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
The technical component of a diagnostic procedure is only eligible for payment where the physician has the necessary training and experience to personally render the technical component of the service.
The physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
All insured services must be documented in appropriate records to establish that:
1. an insured service was provided;
2. the service for which the account is submitted is the service that was rendered; and
3. the service was medically necessary.
Dental x-rays of the teeth are not an insured benefit.
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