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X201
X201 – Breast biopsy specimen x-ray
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
X201 is for the radiological examination of a breast biopsy specimen. The fee is payable per specimen. This service is comprised of a technical component (H) and a professional component (P) which are claimed separately. See 'Payment Adjustment Rules' for billing details.
When to Use
- Use X201 to bill for the radiological verification of a breast biopsy specimen immediately following an image-guided core biopsy or vacuum-assisted excision to confirm the presence of calcifications.
- Use this code when performing intra-operative specimen radiography to ensure the target lesion has been successfully captured in the excised tissue.
Common Pitfalls
- Failing to append the correct suffix (B for technical, C for professional) will result in automatic rejection or incorrect payment processing.
- Billing the technical component (suffix B) for a patient who is an inpatient or who is admitted to the hospital within 24 hours of the procedure is a violation of the Health Insurance Act and will trigger audit recovery.
- Attempting to bill X201 for general diagnostic mammography (e.g., X101) instead of specific specimen radiography is a common coding error that leads to claim rejection.
Billing Tips
- Always ensure the technical component (suffix B) is only claimed for services rendered in a non-hospital setting, as hospital-based technical services are bundled into the hospital's global budget.
- If you are the radiologist interpreting the specimen image, ensure you are billing the professional component (suffix C) separately from the technical component to ensure full remuneration.
Provider Fee$0.00
Surgical Assistant Fee$6.80
Anaesthetist Fee$5.20
Non-Anaesthetist Fee$5.20
Effective: April 1, 2025
Category
D. Diagnostic Radiology
Subcategory
DIAGNOSTIC RADIOLOGY
Service Type
Diagnostic
Code Classes
Diagnostic Radiology
Referral RequiredFrom: Physician, NursePractitioner, Midwife, OralMaxillofacialSurgeon
The Act requires that the record 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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