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X498
X498 – Repeat MRI - complex spine
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
This service is for a repeat multislice sequence MRI of a complex spine, defined as 2 or more non-adjoining spinal segments. A repeat constitutes imaging in another plane or with a different pulse sequence. It is billed in conjunction with the primary complex spine MRI scan (X496). This repeat service is limited to a maximum of 3 times per patient, per day.
When to Use
- Use X498 when performing a repeat scan in a different plane or with a distinct pulse sequence for a patient already undergoing a primary complex spine MRI (X496).
- Apply this code specifically when imaging 2 or more non-adjoining spinal segments that require additional sequences beyond the initial X496 protocol.
Common Pitfalls
- Billing X498 without an associated X496 claim will result in an automatic rejection as it is an add-on service.
- Exceeding the daily limit of 3 units per patient will trigger a rejection; ensure the count reflects only distinct planes or sequences.
- Confusing X498 with standard spine codes like X486 or X487, which do not meet the 'complex' criteria of 2 or more non-adjoining segments.
Billing Tips
- Ensure the clinical documentation explicitly notes the 'different plane' or 'different pulse sequence' to justify the repeat service during an audit.
- Always link X498 to the primary X496 claim on the same submission to maintain the required billing relationship.
Provider Fee$0.00
Non-Anaesthetist Fee$50.65
Effective: April 1, 2025
Category
F. Magnetic Resonance Imaging (MRI)
Subcategory
MAGNETIC RESONANCE IMAGING (MRI)
Service Type
Diagnostic
Code Classes
Magnetic Resonance Imaging (MRI)
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
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