All codes
T109
T109 – T109
OHIP Other Code · Schedule of Benefits
When to Use
- Use T109 for the initial consultation of a patient with a suspected or confirmed malignancy when the service is provided by a specialist in medical oncology or hematology.
- Select T109 when the complexity of the malignancy assessment requires a comprehensive review of diagnostic imaging, pathology reports, and treatment planning that exceeds the scope of a standard A005 consultation.
Common Pitfalls
- Billing T109 in conjunction with a subsequent visit code like A007 on the same day is a common rejection trigger unless specific criteria for a separate, unrelated problem are met.
- Submitting T109 without a valid referring physician number or failing to include the required diagnostic code for the malignancy will result in an automatic claim rejection.
Billing Tips
- Ensure the consultation note clearly documents the time spent and the complexity of the decision-making process to justify the higher fee compared to standard consultation codes.
Provider Fee$263.00
Specialist Fee$263.00
Effective: February 1, 2011
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.