All codes
X499
X499 – Three Dimensional MRI acquisition sequence
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
Three Dimensional MRI acquisition sequence, including post-processing (minimum of 60 slices; maximum 1 per patient per day).
When to Use
- Use X499 when the MRI protocol specifically requires a 3D acquisition sequence, such as 3D T1-weighted spoiled gradient echo (e.g., MP-RAGE) or 3D FLAIR, provided the sequence generates at least 60 slices.
- Use this code for advanced post-processing requirements where volumetric data reconstruction is necessary for clinical interpretation, distinguishing it from standard 2D multi-planar imaging.
Common Pitfalls
- Billing X499 for standard 2D sequences that do not meet the 60-slice minimum threshold will lead to audit recovery.
- Attempting to bill X499 more than once per patient per day is strictly prohibited by the Schedule of Benefits and will result in automatic rejection.
- Failing to document the specific 3D sequence and slice count in the technical report creates a significant documentation gap during OHIP audits.
Billing Tips
- Ensure your PACS or MRI reporting software automatically logs the slice count to provide verifiable evidence of the 60-slice requirement for every X499 claim.
- When performing urgent, after-hours MRI services, X499 can be billed in conjunction with applicable special visit premiums (e.g., C104, C110) provided all criteria for those premiums are met.
Provider Fee$0.00
Anaesthetist Fee$32.70
Non-Anaesthetist Fee$32.70
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
All insured services must be documented in appropriate records that establish: 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.
Minimum of 60 slices.
Maximum 1 per patient per day.
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