X055 – Wrist and hand - two or three views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
When to Use
- Use X055 for standard wrist or hand trauma series where only two or three views are clinically indicated and performed.
- Select X055 when imaging a single anatomical region (wrist or hand) that does not meet the four-view threshold required for X220.
Common Pitfalls
- Billing X055 for a four-view series will trigger a rejection or audit risk; use X220 if four or more views are captured.
- Attempting to bill the technical component for patients who are hospital in-patients or admitted within 24 hours of the service will result in automatic payment recovery.
Billing Tips
- Ensure the requisition clearly specifies the number of views requested to justify the selection of X055 over higher-intensity codes like X220.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The medical record must establish that: - an insured service was provided; - the service for which the account is submitted is the service that was rendered; and - the service was medically necessary.
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. The physician submitting the 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.
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