X019 – Salivary gland region
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A radiological examination of the salivary gland region. This service is a diagnostic procedure with two distinct components as listed on page : a technical component (H) and a professional component (P). As per the General Preamble on page , the technical component (H) is only insured when rendered in a hospital setting and is not payable for hospital in-patients or for out-patients who are subsequently admitted within 24 hours for the same condition. Claims for the technical component should be submitted with a 'B' suffix, and claims for the professional component with a 'C' suffix. Note: Dental x-rays of the teeth are not an insured benefit.
When to Use
- Use X019C for the professional interpretation of a sialography or diagnostic imaging of the salivary glands when ordered by a physician or oral surgeon.
- Use X019B only when the technical imaging procedure is performed in a hospital setting for an out-patient who is not admitted within 24 hours.
Common Pitfalls
- Billing X019B for patients who are admitted to the hospital within 24 hours of the procedure, which is a direct violation of the General Preamble.
- Submitting X019 for dental-related imaging, as dental x-rays are explicitly excluded from OHIP coverage and will be rejected.
- Failing to use the correct suffix (B for technical, C for professional), which will result in claim rejection or incorrect payment processing.
Billing Tips
- Ensure the professional component X019C is billed with the appropriate diagnostic code to justify the medical necessity of the salivary gland examination.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records establishing 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 ().
From : For diagnostic services which have both technical and professional components listed under one fee schedule code, the technical and professional components are claimed separately. The claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
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