All codes
T351
T351 – T351
OHIP Other Code · Schedule of Benefits
When to Use
- Use T351 for the surgical repair of a complete or incomplete cleft palate, typically performed by a plastic surgeon or otolaryngologist.
- Apply this code when performing a primary palatoplasty in a pediatric patient to address velopharyngeal insufficiency or anatomical clefting.
Common Pitfalls
- Billing T351 in conjunction with other major surgical codes for the same site may trigger a 'multiple procedure' reduction; ensure the operative report clearly distinguishes separate anatomical procedures.
- Submitting T351 without the appropriate diagnostic code for the specific type of cleft (e.g., Q35.x) will result in an automatic rejection for lack of medical necessity.
Billing Tips
- If a secondary revision or pharyngoplasty is required later, use the appropriate secondary repair codes rather than re-billing T351, as T351 is intended for the primary definitive repair.
Provider Fee$552.80
Specialist Fee$552.80
Effective: February 1, 2011
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