X425 – Repeat MRI (another plane, different pulse sequence)
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
This service is for a repeat Magnetic Resonance Imaging (MRI) of the head. It is performed using another plane or a different pulse sequence than the initial scan (X421). This service can be claimed up to a maximum of 2 times. An additional fee (E876) is payable if magnetic resonance spectroscopy is performed concurrently.
When to Use
- Use X425 when a second plane or distinct pulse sequence is required to clarify findings identified in the initial X421 head MRI.
- Use X425 for up to two additional sequences beyond the base X421 scan when clinical diagnostic requirements necessitate further imaging planes.
Common Pitfalls
- Billing X425 as a standalone code without an associated X421 claim will result in rejection as it is a secondary service.
- Exceeding the maximum of two claims for X425 per patient per session will trigger an automatic audit or rejection.
- Failing to append E876 when spectroscopy is performed results in lost revenue, as E876 is not automatically triggered by X425.
Billing Tips
- Ensure the clinical necessity for the additional plane or sequence is clearly documented to justify the use of X425 over the base X421 fee.
- Always pair E876 with X425 on the same claim submission when magnetic resonance spectroscopy is performed to ensure the flat fee is captured.
Effective: April 1, 2025
F. Magnetic Resonance Imaging (MRI)
MAGNETIC RESONANCE IMAGING (MRI)
Diagnostic
Magnetic Resonance Imaging (MRI)
Medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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