All codes
T118
T118 – T118
OHIP Other Code · Schedule of Benefits
When to Use
- Use T118 for the initial consultation and assessment of a patient requiring a complex, multi-system evaluation that exceeds the scope of a standard A005 or A007 consultation.
- Apply this code when performing a comprehensive review of a patient with significant diagnostic uncertainty or treatment failure, provided the requirements for a formal consultation are met.
Common Pitfalls
- Billing T118 for a follow-up visit or a routine assessment, which should instead be billed under A008 or equivalent subsequent visit codes.
- Failure to meet the formal consultation requirements, such as a written request from a referring physician, which leads to automatic rejection or recovery during an audit.
Billing Tips
- Ensure the referral source is clearly documented in the claim submission to avoid rejection, as T118 requires a formal request from a primary care provider or another specialist.
Provider Fee$438.25
Specialist Fee$438.25
Effective: February 1, 2011
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