X105 – Palatopharyngeal analysis - cine or videotape
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Palatopharyngeal analysis performed with cine or videotape. This is a diagnostic radiology procedure of the gastrointestinal tract. This service is comprised of two distinct components for billing purposes: - Professional Component (P Fee): Claimed as X105C, with a fee of $36.90. This covers the physician's work in interpreting the images and providing a report. - Technical Component (H Fee): Claimed as X105B, with a fee of $29.50. This covers the cost of equipment, supplies, and personnel for performing the scan. The technical component is subject to specific payment rules when rendered in a hospital setting (see ).
When to Use
- Use X105C when performing the professional interpretation and reporting of a cine or videotape palatopharyngeal analysis.
- Use X105B when billing for the technical component, provided you are responsible for the quality assurance, data acquisition, and record-keeping associated with the procedure.
Common Pitfalls
- Attempting to bill X105B or X105C for services rendered via PACS or outside of a hospital setting, which disqualifies the claim from associated special visit premiums.
- Billing X105B and X105C together with multiple special visit premiums; only one premium is eligible per patient per visit.
Billing Tips
- Ensure the referral source is documented as a physician, nurse practitioner, or oral maxillofacial surgeon to meet the mandatory referral requirement.
- Verify that the service is documented as medically necessary and that the technical component physician maintains the required quality assurance records to survive a potential MOH audit.
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 this upon request by the MOH.
All insured services must be documented in appropriate records to 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.
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