X126

PDF page 379 / D21

DIAGNOSTIC RADIOLOGY
 COMPUTED TOMOGRAPHY (CT)
                                                                                                H    P
         [Commentary:
         1.For services where the heart vasculature and structures are not being visualized for the
           indications above, CT thorax (X406, X407 and/or X125) may be payable instead of X235.
         2.The maintenance of radiation dose should be consistent with the As Low As Responsibly
           Achievable principle and current standards under the direction of the radiologist Radiation
           Protection Officer.
         3.Ontario Clinical Guidance on Patient Selection and Prioritization for Coronary Computed
           Tomography Angiography can be found at https://www.corhealthontario.ca/Provincial-
           Clinical-Guidance-on-CCTA_Final.pdf] ]
     Abdomen
   X409 - without IV contrast..............................................................     -    86.60
   X410 - with IV contrast...................................................................   -    97.50
   X126 - with and without IV contrast ...............................................          -   108.30
     Pelvis
   X231 - without IV contrast..............................................................     -    86.60
   X232 - with IV contrast...................................................................   -    97.50
   X233 - with and without IV contrast ...............................................          -   108.30
   X234 CT colonography .................................................................... - 235.30
       Note:
       1.X234 includes all elements required to perform the study, including additional CT acquisition
         sequencing and/or post processing, two or three dimensional reconstruction(s),
         administration of contrast, and faecal tagging, if rendered.
         2.X417, X409, X410, X126, X231, X232, X233 are not eligible for payment with X234.
         Payment rules:
         1.CT colonography is an insured service only in the following circumstances:
            a.individuals who are at moderate risk for colorectal cancer based on family history and the
              patient refuses colonoscopy or where the patient has been advised of the relative risks
              and benefits of CT colonography and colonoscopy and the patient refuses colonoscopy;
            b.for surveillance examination in patients with a history of previous colonic neoplasm,
              where clinically appropriate;
            c.for diagnostic examination in symptomatic patients;
         [Commentary:
         Examples of relevant symptomatology include unexplained abdominal pain, diarrhea,
         constipation, gastrointestinal bleeding, anemia, intestinal obstruction, or weight loss.]
             d.when rendered for a patient for whom colonoscopy is technically infeasible, has been
                difficult in the past, or contraindicated;
             e.for patients who are at increased risk for complications during endoscopy such as,
                advanced age, sedation or anti-coagulation therapy, prior incomplete or difficult
                colonoscopy;
             f. when double contrast barium enema services are unavailable or regarded as inadequate
                for clinical or diagnostic reasons.

Master, record 6574. Record Layout PDF, page 1.

X12620250401999999990000000000000000000000000000000000000000000000001083000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.