X147 – Hysterosalpingogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Hysterosalpingogram is a diagnostic imaging procedure used to examine the uterine cavity and fallopian tubes. As per the Schedule of Benefits, this service is compensated with a split fee: a technical component (H-fee) for the facility, equipment, and technical staff, and a professional component (P-fee) for the physician's interpretation and report. Specific payment rules from the General Preamble apply, particularly regarding the eligibility of the technical component when rendered in a hospital setting (). The professional component is for the physician's service of interpretation.
When to Use
- Use X147 for diagnostic imaging of the uterine cavity and fallopian tubes to investigate infertility or suspected anatomical abnormalities.
- Use this code when performing a hysterosalpingogram as a standalone diagnostic procedure, ensuring the professional component is claimed for your interpretation and report.
Common Pitfalls
- Claiming the technical component (H-fee) for an in-patient is a direct violation of GP11 and will result in automatic rejection.
- Failing to account for the 24-hour rule: if an out-patient is admitted to the same hospital within 24 hours for the same condition, the technical component (H-fee) is ineligible for payment.
- Attempting to bill X147 without a valid referral from a physician, nurse practitioner, or oral maxillofacial surgeon, which is a mandatory requirement under GP111.
Billing Tips
- Ensure your claim clearly separates the professional component (P-fee) and technical component (H-fee) to comply with the split-fee structure, provided the setting and patient status allow for the technical component.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records that establish an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
Female
The fee for this service is split into a technical component (H: $29.80) and a professional component (P: $11.35).
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