All codes
T225
T225 – T225
OHIP Other Code · Schedule of Benefits
When to Use
- Use T225 for the initial consultation of a patient referred for a specific psychiatric assessment when the patient is seen in a hospital setting.
- Apply this code when the consultation requires a comprehensive psychiatric evaluation that exceeds the scope of a standard A005 or A007 assessment.
Common Pitfalls
- Billing T225 in conjunction with a subsequent visit code like C007 on the same day is a common rejection trigger.
- Failing to include a valid referring physician number on the claim will result in an automatic rejection by OHIP.
- Using T225 for a follow-up visit instead of the appropriate subsequent visit code is a frequent audit flag for overbilling.
Billing Tips
- Ensure the referral is documented as a formal request from another physician or nurse practitioner to satisfy the consultation requirement.
- If the patient is seen in an emergency department, ensure the claim reflects the appropriate hospital location code to avoid payment discrepancies.
Provider Fee$96.58
Specialist Fee$96.58
Effective: February 1, 2011
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