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T105
T105 – T105
OHIP Other Code · Schedule of Benefits
When to Use
- Use T105 for the initial consultation of a patient with a confirmed diagnosis of a malignant neoplasm requiring complex oncological management.
- Apply this code when the clinical assessment involves a comprehensive review of diagnostic imaging, pathology reports, and treatment planning for a new cancer diagnosis.
Common Pitfalls
- Billing T105 for a follow-up visit or a routine review of a patient already established in your oncological care plan, which should instead be billed as a subsequent visit code.
- Submitting T105 without a formal consultation report sent to the referring physician, which is a mandatory requirement for all consultation-level billing.
- Attempting to bill T105 in conjunction with a minor procedure code on the same day, which often triggers an automatic rejection due to the comprehensive nature of the consultation fee.
Billing Tips
- Ensure the referral source is clearly documented in the claim, as T105 is strictly reserved for physician-to-physician referrals.
- If the consultation exceeds the time parameters or complexity typically associated with T105, review the Schedule of Benefits to determine if a time-based premium or a different consultation code is more appropriate for the specific specialty.
Provider Fee$307.20
Specialist Fee$307.20
Effective: February 1, 2011
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