All codes
T126
T126 – T126
OHIP Other Code · Schedule of Benefits
When to Use
- Use T126 for the initial consultation of a patient referred for a formal assessment of a suspected or confirmed malignancy.
- Apply this code when the consultation involves a comprehensive review of diagnostic imaging and pathology reports to establish a staging or treatment plan.
Common Pitfalls
- Do not bill T126 if a consultation for the same condition was performed by a physician in the same group within the preceding 12 months; use a follow-up visit code instead.
- Avoid billing T126 concurrently with a minor procedure code on the same day unless the procedure is distinct and unrelated to the consultation assessment.
Billing Tips
- Ensure the referral note is clearly documented in the chart, as the Ministry frequently audits T126 claims to verify the referring physician's request and the specialist's written report.
Provider Fee$128.52
Specialist Fee$128.52
Effective: April 1, 2025
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