X170 – Laryngogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A laryngogram is a 'Miscellaneous Examination' listed in the Diagnostic Radiology section of the Schedule. It is an imaging procedure used to visualize the larynx. Payment for this service is separated into a professional component (P fee of $23.00) and a technical component (H fee of $28.95). Payment Rules: - The technical component (H) is only eligible for payment when the service is rendered in a hospital (). - The physician claiming the technical component must meet training, experience, and quality assurance documentation requirements as outlined on . - The technical component is not payable for a hospital in-patient or for an out-patient who is subsequently admitted to the same hospital within 24 hours for the same condition ().
When to Use
- Use X170 when performing a formal laryngogram to visualize the larynx, distinct from standard diagnostic imaging codes like X163 or X164.
- Claim the technical component (H) only when the procedure is performed within a hospital setting and you have documented compliance with GP11 quality assurance standards.
Common Pitfalls
- Claiming the technical component (H) for an in-patient or an out-patient who is admitted to the same hospital within 24 hours will result in a rejection.
- Billing the technical component (H) for services rendered outside of a hospital, such as via PACS, is strictly prohibited and will be clawed back during an audit.
- Attempting to bill X170 in conjunction with other special visit premiums for the same patient encounter will lead to payment denials.
Billing Tips
- Ensure your documentation explicitly supports the medical necessity of the urgent interpretation if you are attaching a special visit premium (e.g., C108, C110) to the X170 claim.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
All insured services must be documented in appropriate records that establish the service was provided, is the service submitted for claim, and was medically necessary.
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