X135 – Cystourethrogram, stress or voiding (catheter)
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Cystourethrogram, stress or voiding (catheter) is a diagnostic imaging procedure of the bladder and urethra. This service has both a technical component (Fee H: $27.50) and a professional component (Fee P: $13.80).
- The Technical Component (Fee H) is claimed with suffix B. It is not eligible for payment if rendered outside of a hospital. It is also not eligible for payment if the service is rendered to a hospital in-patient, or to an out-patient who is admitted to the same hospital within 24 hours for the same condition.
- The Professional Component (Fee P) is claimed with suffix C.
When to Use
- Use X135 for diagnostic imaging of the bladder and urethra via catheterization to assess for vesicoureteral reflux or urethral pathology.
- Select X135 when performing a stress cystourethrogram to evaluate for stress urinary incontinence, distinguishing it from standard voiding studies.
Common Pitfalls
- Claiming the technical component (suffix B) for hospital in-patients or patients admitted within 24 hours of the procedure will result in automatic rejection.
- Billing the technical component (suffix B) for procedures performed outside of a hospital setting is ineligible for payment under the Health Insurance Act.
- Failing to separate the professional component (suffix C) and technical component (suffix B) into two distinct claims will lead to processing errors.
Billing Tips
- Ensure the professional component (suffix C) is billed for the interpretation, while the technical component (suffix B) is billed only when the facility requirements are met.
- If performing this procedure as an urgent, non-elective service in an acute care hospital after hours, you may be eligible to append a special visit premium (e.g., C109 or C110) to the professional component.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The physician has the necessary training and experience to personally render the technical component of the service;
The physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
For those diagnostic services which have both technical and professional components listed under one fee schedule code, the technical and professional components are claimed separately. The claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
The technical component may be listed as either "technical component" or in a column headed "H" or "T". The professional component may be listed as either "professional component" or in a column headed "P".
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