All codes
T121
T121 – T121
OHIP Other Code · Schedule of Benefits
When to Use
- Use T121 for a formal consultation requested by a referring physician for a patient with a specific clinical problem requiring an opinion.
- Use this code when the patient has not been seen by you for the same condition within the preceding 12 months, distinguishing it from a repeat consultation (T122).
- Apply T121 when the consultation occurs in a hospital or office setting, provided the written request and subsequent report are documented.
Common Pitfalls
- Billing T121 when the patient is a return visit for the same condition within 12 months, which should instead be billed as a repeat consultation (T122) or a follow-up visit (A007).
- Failing to ensure the referring physician's name and billing number are included in the claim, which is a mandatory requirement for consultation codes.
- Submitting T121 for a patient who has been seen by a partner in the same group practice for the same condition, as this is often rejected as a non-consultation.
Billing Tips
- Ensure the consultation report is dated and sent to the referring physician, as OHIP auditors frequently cross-reference the claim date with the report generation date.
- If the consultation results in a procedure, you may bill the procedure code in addition to T121, provided the consultation was a distinct service.
Provider Fee$150.94
Specialist Fee$188.70
Effective: April 1, 2025
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