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T204
T204 – T204
OHIP Other Code · Schedule of Benefits
When to Use
- Use T204 for the initial assessment of a patient with a confirmed diagnosis of malignant neoplasm when the service is provided by a consultant in oncology.
- Apply T204 when performing a comprehensive consultation for a new patient referral specifically regarding the management of a malignant condition.
- Select T204 instead of A007 when the complexity of the malignant neoplasm assessment exceeds the scope of a standard internal medicine consultation.
Common Pitfalls
- Billing T204 in conjunction with a minor assessment code like A001 on the same day for the same patient will result in an automatic rejection.
- Submitting T204 without a valid referring physician number or failing to include the required diagnostic code for the malignancy will lead to claim denial.
- Attempting to bill T204 for a follow-up visit instead of the appropriate subsequent visit code (e.g., C007) is a frequent cause of audit recovery.
Billing Tips
- Ensure the consultation note explicitly details the malignant diagnosis and the specific oncological management plan to support the higher fee value of T204.
- Verify that the referral was initiated by another physician, as T204 is strictly reserved for formal consultations and not self-referred or patient-initiated visits.
Provider Fee$218.40
Specialist Fee$218.40
Effective: February 1, 2011
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