X480 – MRI guidance of biopsy or lesion ablation, breast, unilateral
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
MRI guidance of biopsy or lesion ablation for a unilateral breast lesion. Note: Per page , X480 is only eligible for payment when a lesion can only be visualized by MRI or the use of another image guidance modality is not technically feasible. Commentary: - X487 and/or X499 may be eligible for payment in addition to X480. - Biopsy fee codes specific to the breast may also be eligible for payment.
When to Use
- Use X480 when a breast lesion is occult on both mammography and ultrasound, requiring MRI-guided localization or biopsy.
- Use X480 when a patient has a contraindication to ultrasound or stereotactic guidance, making MRI the only technically feasible modality for the procedure.
Common Pitfalls
- Billing X480 alongside X446 or X447 will result in a rejection, as these codes are mutually exclusive for breast biopsy guidance.
- Submitting X480 without clear clinical justification for why ultrasound or stereotactic guidance was not feasible risks audit recovery under the F2:380 requirement.
- Failure to include the specific breast biopsy procedural code in addition to X480 results in under-billing, as X480 covers the guidance component only.
Billing Tips
- Always append X487 for gadolinium and X499 for 3D sequences if performed, as these are separately payable add-ons that maximize the claim value.
- Ensure the referring physician's information is correctly linked to the claim, as X480 requires a valid referral to be eligible for payment.
Effective: April 1, 2025
F. Magnetic Resonance Imaging (MRI)
MAGNETIC RESONANCE IMAGING (MRI)
Procedure
Magnetic Resonance Imaging (MRI), Clinical Procedures associated with Diagnostic Radiological Examinations
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