All codes
T219
T219 – T219
OHIP Other Code · Schedule of Benefits
When to Use
- Use T219 for the initial consultation of a patient referred for a specific surgical or procedural assessment when the patient has not been seen by your specialty for this condition within the last 12 months.
- Select T219 when the referral is for a comprehensive assessment that exceeds the scope of a standard A007 office visit, provided the referral criteria are met.
Common Pitfalls
- Billing T219 for a patient who has been seen by you or a partner in the same group for the same diagnosis within the previous 12 months, which should instead be billed as a repeat consultation or assessment.
- Submitting T219 without a valid referring physician number or failing to maintain the formal written referral request in the patient record, which leads to automatic rejection during Ministry audits.
Billing Tips
- Ensure the referral letter specifically requests a consultation; if the referral is for a 'transfer of care' or 'ongoing management', T219 is ineligible and you must use the appropriate assessment code instead.
Provider Fee$134.38
Specialist Fee$134.38
Effective: February 1, 2011
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