X206 – Lumbar or lumbosacral spine - six or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A radiological examination of the lumbar or lumbosacral spine, consisting of six or more views. This service is listed with separate fees for the technical component (H) and the professional component (P). The professional component involves the physician's interpretation of the images. Payment for the technical component is subject to specific rules based on the location of service (e.g., hospital vs. out-of-hospital). Per (), the technical component is claimed with suffix B, and the professional component with suffix C.
When to Use
- Use X206 when a clinical request specifically necessitates a detailed lumbar or lumbosacral series requiring six or more distinct radiographic projections.
- Select X206 instead of X205 when the diagnostic requirement exceeds the standard five-view series, such as in complex post-surgical evaluations or detailed instability assessments.
Common Pitfalls
- Submitting the technical component (X206B) for hospital inpatients or patients admitted within 24 hours of the study is a frequent cause of automatic rejection.
- Billing X206B for out-of-hospital services is prohibited; the technical component must be billed only when the service is performed within an eligible hospital facility.
- Confusing the professional component (X206C) with the technical component (X206B) and failing to use the correct suffix, which results in payment processing errors.
Billing Tips
- Always ensure the professional component (X206C) is claimed separately from the technical component (X206B) to ensure accurate adjudication of both the physician's interpretation and the facility fee.
- Verify that the requisition clearly documents the medical necessity for six or more views to support the higher-tier code over the standard X205 series.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
This service is for six or more views.
The technical component ('H' fee) and professional component ('P' fee) are claimed separately. The H fee is for the facility/technical aspect, and the P fee is for the physician's interpretation.
The technical component ('H' fee) is not eligible for payment if rendered to a hospital in-patient, or to a patient who is admitted to the same hospital within 24 hours of the service for the same condition. See () for details.
The technical component ('H' fee) for this service is not eligible for payment if rendered outside of a hospital.
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