All codes
T364
T364 – T364
OHIP Other Code · Schedule of Benefits
When to Use
- Use T364 for the initial consultation of a patient with a confirmed or suspected diagnosis of a malignant neoplasm, provided the patient has not been seen by you for the same condition in the previous 12 months.
- Apply this code when performing a comprehensive assessment of a new oncology patient, which includes a detailed history, physical examination, and the development of a formal treatment plan.
- Use T364 instead of A007 when the complexity of the malignant disease requires a specialized oncological evaluation that exceeds the scope of a standard internal medicine consultation.
Common Pitfalls
- Billing T364 for a follow-up visit or a routine review of a patient already under your active care for the same malignancy, which should be billed as a subsequent visit code.
- Submitting T364 without a formal referral from another physician, as this code strictly requires a valid referral to be eligible for payment.
- Failing to include the referring physician's billing number on the claim, which will result in an automatic rejection by the Ministry of Health.
Billing Tips
- Ensure the clinical documentation explicitly supports the complexity of the malignant condition to withstand potential post-payment audits regarding the necessity of a specialist-level consultation.
- If the consultation results in a decision to perform a procedure on the same day, ensure you are aware of the specific rules regarding the combination of T364 with surgical procedure codes to avoid bundling rejections.
Provider Fee$243.20
Specialist Fee$243.20
Effective: April 1, 2025
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