All codes
T363
T363 – T363
OHIP Other Code · Schedule of Benefits
When to Use
- Use T363 for the surgical repair of a full-thickness rotator cuff tear when performed as an open or arthroscopic procedure.
- Apply this code when the clinical documentation confirms the repair of a significant tendon tear requiring formal reattachment to the humerus, distinguishing it from simple debridement (which would fall under a different minor procedure code).
- Select T363 when the procedure is the primary surgical intervention for a chronic or acute rotator cuff injury that has failed conservative management.
Common Pitfalls
- Billing T363 in conjunction with a diagnostic arthroscopy (e.g., S111) is considered unbundling, as the diagnostic component is included in the global fee for the repair.
- Submitting T363 without clear evidence of a full-thickness tear in the operative report often leads to audit recovery or downgrading to a lesser procedure code.
- Failing to account for the global surgical period, which precludes billing for routine post-operative follow-up visits (A007) within the specified timeframe.
Billing Tips
- Ensure the operative note explicitly details the size of the tear and the specific fixation technique used, as these details are critical for justifying the T363 fee during a Ministry review.
Provider Fee$2,048.00
Specialist Fee$2,048.00
Effective: April 1, 2025
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