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X165
X165 – Photographic subtraction
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Photographic subtraction is a miscellaneous diagnostic radiology examination. This service represents the professional component ('P' fee) of the procedure. The payment for this service is subject to the general rules for diagnostic services as outlined in the to of the Schedule of Benefits. The professional component is payable to the physician interpreting the examination. The technical component ('H' fee) for this service is not an insured service.
When to Use
- Use X165 when performing professional interpretation of photographic subtraction images for diagnostic purposes.
- Use this code specifically for the professional component ('P' fee) when the technical component ('H' fee) is provided by the facility.
Common Pitfalls
- Billing X165 for the technical component, which is not an insured service and will result in rejection.
- Attempting to bill X165 without a valid referral from a physician, nurse practitioner, or oral maxillofacial surgeon as required by GP16.
- Submitting X165 for services rendered outside of a hospital setting when attempting to claim associated special visit premiums like C102 or C104.
Billing Tips
- Ensure the claim is submitted with the 'P' prefix to correctly identify the professional component for the interpreting radiologist.
- Apply age-based premiums (e.g., AGE_PREMIUM_UNDER_1_YEAR) if the patient meets the specific age criteria, as X165 is a clinical procedure associated with diagnostic radiology.
Provider Fee$0.00
Non-Anaesthetist Fee$11.35
Effective: April 1, 2025
Category
D. Diagnostic Radiology
Subcategory
DIAGNOSTIC RADIOLOGY
Service Type
Diagnostic
Code Classes
Diagnostic Radiology
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
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