X475 – Repeat MRI - extremity or joint
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
This service is for a repeat multislice sequence for one extremity or one joint, performed in another plane or using a different pulse sequence. It is billed in conjunction with the initial study (X471) and is limited to a maximum of three repeats per examination. Eligible joints include the shoulder, elbow, wrist, hip, knee, and ankle.
When to Use
- Use X475 to bill for additional sequences in a different plane (e.g., sagittal vs. axial) for a single joint already billed under X471.
- Use X475 when a different pulse sequence is required to characterize a specific lesion or pathology identified during the initial study.
Common Pitfalls
- Billing X475 more than three times per examination will trigger an automatic rejection as it exceeds the defined maximum.
- Attempting to bill X475 for a second joint or extremity is incorrect; use X488 or X489 for multi-joint imaging instead.
- Submitting X475 without an associated X471 claim on the same service date will result in a rejection for missing the primary procedure.
Billing Tips
- Ensure the clinical necessity for the additional plane or sequence is clearly documented in the radiology report to support the repeat billing.
Effective: April 1, 2025
F. Magnetic Resonance Imaging (MRI)
MAGNETIC RESONANCE IMAGING (MRI)
Diagnostic
Magnetic Resonance Imaging (MRI)
1. X488 and X489 require imaging of two extremities or two or more joints in the same extremity during the same examination at one sitting.
2. X488 and X489 requires separate surface coil, separate imaging sequence, separate filming and separate post-processing for each joint examined.
3. For the purposes of X471, X475, X488 and X489, the following are considered eligible joints: shoulder, elbow, wrist, hip, knee and ankle.
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