X202 – Cervical spine - four or five views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure for the cervical spine consisting of four or five views. This service is comprised of two distinct components as defined in and : - A technical component (H fee) for the performance of the imaging. - A professional component (P fee) for the physician's interpretation and report. Payment rules from state: - The technical component is not eligible for payment if the service is rendered to a hospital in-patient. - The technical component is not eligible for payment if the patient attends a hospital for the service and is admitted to the same hospital within 24 hours for the same condition. - The technical component is not eligible for payment if rendered outside of a hospital.
When to Use
- Use X202 when a standard cervical spine series requires four or five views, such as AP, lateral, odontoid, and oblique projections.
- Select X202 instead of X025 (which covers fewer views) when the clinical suspicion of fracture or instability necessitates the additional oblique or flexion/extension views.
Common Pitfalls
- Billing the technical component (H fee) for hospital in-patients, which is strictly prohibited under GP11 rules.
- Submitting X202 when only three views were performed, as this constitutes an over-billing error; use X025 for three views instead.
- Failing to account for the 24-hour rule where the technical component is rejected if the patient is admitted to the same hospital shortly after an outpatient diagnostic study.
Billing Tips
- Ensure the report explicitly lists the views obtained to justify the four or five-view requirement of X202 over the lower-level X025.
- If performing urgent after-hours interpretations in a hospital setting, verify eligibility for C105 premiums to maximize the professional component reimbursement.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records. 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.
The fee for this service applies to a study of the cervical spine with four or five views.
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