X401

PDF page 360 / D2

OTHER TERMS AND DEFINITIONS
                                        DIAGNOSTIC RADIOLOGY
    PREAMBLE
 OTHER TERMS AND DEFINITIONS
   1. Professional and technical components are claimed separately. Claims for technical component
      H are submitted using the listed fee code with suffix B. Claims for professional component P are
      submitted using the listed fee code with suffix C.
             2. For services rendered outside a hospital setting the only fees billable under the Health
                Insurance Act are listed under the column P (use suffix C). Costs for the technical component of
                these services are only claimed under the Integrated Community Health Services Centres Act,
                2023. Costs for the technical component of services rendered in an ICHSC are listed in the
                Schedule of Facility Costs.
             3. Benefits for clinical procedures related to x-ray examinations are listed in the following section,
                or under Diagnostic and Therapeutic or Surgical Procedures. ‘Clinical Procedures’, in this
                context, are those by which contrast media are introduced, except oral or rectal administration
                for study of the alimentary tract, and intravenous injections, which are an integral part of the
                study, performed by the physician collecting the benefit for the procedure.
             4. If less than the minimum number of views are performed, reduce listed fees by 25%.
             5. If insured diagnostic radiology procedures yield abnormal findings or if they would yield
                information which in the opinion of the radiologist would be insufficient governed by the needs of
                the patient and the requirements of the referring provider or practitioner, the radiologist may add
                further views and claim for them (if listed).
             6. All benefits listed apply to unilateral examinations unless otherwise specified. When a
                radiologist is asked to x-ray one extremity only, no additional claim should be made for
                comparison x-rays initiated by the radiologist.
             7. A stereo pair is to be counted as two views.
             8. No additional claim is warranted for the use of the image intensifier in diagnostic radiology.
             9. Complex head CT scans are meant to be multiplanar (multidirectional) head CT scans - to
                include one or more of the following areas: pituitary fossa, posterior fossa, internal auditory
                meati, orbits and related structures, the temporal bone and its contents and the
                temporomandibular joints. X400, X401 and X188 are not to be billed in addition to those fees for
                complex head studies.
             10. Nasal bones should not be routinely claimed in skull examination requests.
             11. Mandible X006 and Temporomandibular joints X007 are not both to be routinely claimed on the
                 same patient but only when specifically ordered.
             12. Conventional films of the spine should not be routinely done and claimed for before
                 myelography. The necessity of having plain film studies of the spine prior to interpreting the
                 myelographic studies is obvious. It is not essential, however, that these be done at the
                 institution where the myelogram was done. If they have been done at an outside office, then it is
                 a matter for the radiologist and the referring provider to have the films available. If they cannot
                 be made available to the radiologist, it is an acceptable practice for him to do the required
                 procedure of these areas and to claim for them so that they may be available for interpretation
                 along with the myelographic study.
             13. Lumbar or lumbosacral spine X028 does not include the entire sacrum. An x-ray of the sacrum
                 may be carried out and claimed for only when specifically indicated.

PDF page 376 / D18

DIAGNOSTIC RADIOLOGY
      COMPUTED TOMOGRAPHY (CT)
                                                                                                               H             P
                 Head
               X400 - without IV contrast..............................................................   - 43.25
               X401 - with IV contrast................................................................... - 64.95
               X188 - with and without IV contrast ...............................................        - 75.85
               E874    - with CT perfusion study, to X188, X400, X401, X402,
                         X405, or X408 ............................................................ add     64.00
                   Note:
                   1.E874 is only eligible for payment when the study is rendered as part of the investigation of
                     acute stroke and the interpretation is rendered within the limited period of time following
                     acute stroke during which the treating physician must render therapeutic decisions.
                                          2.E874 includes the administration of contrast necessary to complete the CT perfusion study.
                                          3.E874 includes creation and interpretation of post-imaging colour mapping of cerebral
                                            perfusion maps for regional cerebral blood flow, cerebral blood volume, and mean blood
                                            transit time.
                                          [Commentary:
                                          For example, when a CT perfusion study is only performed in conjunction with a non-contrast
                                          CT head scan, the appropriate claim is E874 and the non-contrast CT head service (e.g. X400,
                                          X402). In this example, a claim for E874 with a contrast enhanced CT head service (e.g. X401,
                                          X405) would not be appropriate.]

Master, record 6712. Record Layout PDF, page 1.

X40120250401999999990000000000000000000000000000000000000000000000000649500

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.