All codes
T111
T111 – T111
OHIP Other Code · Schedule of Benefits
When to Use
- Use T111 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of complex diagnostic reports and treatment planning.
- Select T111 when providing a formal consultation for a patient referred by another physician for a specialized opinion on a complex oncological case that meets the time and complexity requirements of a major consultation.
Common Pitfalls
- Billing T111 in conjunction with a minor assessment code like A007 is a common rejection trigger; ensure the service meets the criteria for a major consultation to avoid audit flags.
- Failing to include the referring physician's billing number on the claim will result in an automatic rejection by the Ministry of Health.
Billing Tips
- Ensure the consultation report is sent to the referring physician within the required timeframe, as this is a prerequisite for the validity of the T111 claim.
Provider Fee$350.60
Specialist Fee$350.60
Effective: February 1, 2011
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