X047 – Sternoclavicular joints (bilateral) - two or three views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A bilateral radiographic examination of the sternoclavicular joints requiring two or three views. This service is comprised of a professional component ($17.95) and a technical component ($7.95). Refer to payment adjustment rules regarding the eligibility of the technical component.
When to Use
- Use X047 for bilateral sternoclavicular joint imaging when clinical suspicion of joint pathology requires two or three views.
- Select X047 over X211 when the diagnostic requirement is specifically for the sternoclavicular joints rather than general chest or clavicle imaging.
Common Pitfalls
- Billing the technical component (H fee) when the service is performed in a hospital setting where the facility owns the equipment, as this is often restricted by payment adjustment rules.
- Submitting X047 for a single view or more than three views, as the code is strictly defined for two or three views.
Billing Tips
- Ensure the professional component and technical component are clearly distinguished in your billing software to comply with the $17.95 and $7.95 split requirements.
- Verify that the referral source is documented as a physician, nurse practitioner, or qualified dental/oral surgeon to satisfy the mandatory referral requirement.
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 for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate the above upon request by the MOH.
two or three views
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