X050 – Humerus including one joint - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiological examination of the humerus, including one joint, consisting of two views. This service has a professional and a technical component. The fee of 14.90 represents the total fee, while 6.40 is the professional component only.
When to Use
- Use X050 for a standard two-view humerus series that includes either the shoulder or the elbow joint in the field of view.
- Select X050 when the clinical focus is specifically on the humerus shaft; if the study requires more extensive imaging of the shoulder girdle or elbow, consider if X214 or other specific joint codes are more appropriate.
Common Pitfalls
- Failing to append the correct suffix (B for technical, C for professional) when billing the components separately, which will result in claim rejection.
- Billing X050 when a more comprehensive study of the shoulder (e.g., X214) or elbow was performed, as this constitutes incorrect coding for the anatomical region examined.
Billing Tips
- Ensure the technical component (X050B) is only claimed if you personally oversee the quality assurance and data acquisition process as mandated by the Schedule.
- Always verify that the referral source is an eligible provider (Physician, NP, or Oral Maxillofacial Surgeon) before submitting the claim to avoid audit flags.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records. The Act requires that the record 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.
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 this upon request by the MOH.
The technical component of a diagnostic procedure as described in the relevant section of the Schedule is only eligible for payment where: 1. the physician has the necessary training and experience to personally render the technical component of the service; and 2. the physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
The fee listed after the slash (6.40) is the professional component ('P' fee). The technical component ('H' fee) can be calculated by subtracting the 'P' fee from the total fee (14.90).
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