All codes
T360
T360 – T360
OHIP Other Code · Schedule of Benefits
When to Use
- Use T360 for the definitive 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 formal closure of the palatal defect, distinct from minor revisions or fistula repairs coded under different descriptors.
Common Pitfalls
- Billing T360 in conjunction with other major surgical procedures on the same day without appropriate modifier usage can trigger automatic rejections for unbundling.
- Failing to include the necessary operative report details confirming the complexity of the palatal repair often leads to audit adjustments if the procedure is deemed less extensive than the T360 definition.
Billing Tips
- Ensure that any additional procedures performed during the same operative session are reviewed against the Schedule of Benefits to determine if they are considered inclusive or eligible for a multiple procedure reduction.
Provider Fee$1,074.66
Specialist Fee$1,074.66
Effective: April 1, 2025
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