All codes
T354
T354 – T354
OHIP Other Code · Schedule of Benefits
When to Use
- Use T354 for the surgical repair of a complete or incomplete cleft palate, typically performed by a plastic surgeon or otolaryngologist.
- Apply this code when the procedure involves the primary closure of the palatal defect, distinguishing it from secondary revisions or pharyngoplasty procedures.
Common Pitfalls
- Billing T354 in conjunction with other major surgical codes for the same site may trigger a 'multiple procedure' reduction or rejection if not properly appended with the appropriate modifier.
- Submitting T354 for a minor palatal revision or fistula repair is an error; these should be billed under specific revision codes rather than the primary repair code.
Billing Tips
- Ensure the operative report clearly details the extent of the cleft and the specific closure technique used to support the T354 claim during a potential audit.
Provider Fee$618.70
Specialist Fee$618.70
Effective: February 1, 2011
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