X455 – MRI repeat sequence - Abdomen
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
Magnetic Resonance Imaging (MRI) of the abdomen, repeat scan using another plane or a different pulse sequence. This is typically performed after an initial scan (X451). The service is limited to a maximum of 3 repeats. Payment Rule: As stated on page of the Schedule, X451/X455 are not eligible for payment when used as guidance for organ biopsy. For MRI-guided biopsy, see X481. Diagnostic procedures like MRI generally require a referral from a physician, nurse practitioner, or oral and maxillofacial surgeon as detailed in the General Preamble ().
When to Use
- Use X455 to bill for additional pulse sequences or planes performed immediately following the primary abdominal MRI (X451) to clarify findings.
- Use this code when a specific clinical question requires a targeted repeat sequence, such as a dedicated T2-weighted fat-saturated sequence or a post-contrast phase not included in the initial X451 protocol.
Common Pitfalls
- Billing X455 for MRI-guided biopsies is strictly prohibited; you must use X481 for any imaging performed as guidance for an interventional procedure.
- Exceeding the maximum limit of 3 repeats per patient encounter will result in automatic rejection by the Ministry.
- Attempting to bill X455 as a standalone service without an associated X451 claim will lead to audit flags and payment recovery.
Billing Tips
- Ensure your documentation clearly identifies the specific pulse sequence or plane added as the X455 component to justify the necessity of the repeat scan.
- When providing urgent, non-elective diagnostic services in a hospital setting, ensure you select the appropriate special visit premium (e.g., C108 or C110) to maximize reimbursement for the professional interpretation component.
Effective: April 1, 2025
F. Magnetic Resonance Imaging (MRI)
MAGNETIC RESONANCE IMAGING (MRI)
Diagnostic
Magnetic Resonance Imaging (MRI)
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