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X104
X104 – Oesophagus, stomach and duodenum - double contrast
OHIP Diagnostic Radiology Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure for a double contrast study of the oesophagus, stomach, and duodenum, which includes a survey film if one is taken. This service is comprised of a technical component ('H' fee) and a professional component ('P' fee). Per :, the claim for the technical component is submitted using suffix 'B' and the claim for the professional component is submitted using suffix 'C'. The technical component is only eligible for payment if the service is rendered in a hospital.
Referral requiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
All insured services must be documented in appropriate records that establish: 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. See :.
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