X406 – Thorax CT - without IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service is for a computed tomography (CT) scan of the thorax, performed without the use of intravenous contrast. As a diagnostic service, it is subject to the general rules for diagnostic procedures outlined in the Schedule of Benefits.
When to Use
- Use X406 for non-contrast thoracic CT scans, such as those performed for pulmonary nodule surveillance or interstitial lung disease assessment.
- Use X406 when clinical suspicion of pathology does not require vascular enhancement, distinguishing it from X407 which is specifically for contrast-enhanced thoracic CT.
Common Pitfalls
- Billing X406 in conjunction with PACS-based urgent interpretation premiums (E406, E407, E408) and in-person Special Visit Premiums (e.g., C108, C110) simultaneously; these are mutually exclusive.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the 50% trauma surcharge (E420) for X406.
- Submitting X406 for studies performed with contrast, which will lead to audit discrepancies as X407 is the correct code for contrast-enhanced thorax CT.
Billing Tips
- Ensure the referral source is a physician, nurse practitioner, or oral maxillofacial surgeon, as X406 requires a valid referral to be eligible for payment.
- When providing urgent remote interpretation via PACS, verify that the interpretation is transmitted within the mandatory three-hour window to remain eligible for E406, E407, or E408 premiums.
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.
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