All codes
T368
T368 – T368
OHIP Other Code · Schedule of Benefits
When to Use
- Use T368 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 T368 in conjunction with other major surgical procedures on the same day without appropriate documentation of distinct operative sites may trigger a manual review.
- Failing to include the necessary diagnostic code for cleft palate (e.g., ICD-9 749.0) will result in an automatic rejection of the claim.
Billing Tips
- Ensure that any associated anesthesia services are billed by the anesthesiologist under their respective codes, as T368 covers only the surgeon's professional fee.
Provider Fee$790.27
Specialist Fee$790.27
Effective: April 1, 2025
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