All codes
T369
T369 – T369
OHIP Other Code · Schedule of Benefits
When to Use
- Use T369 for the initial consultation of a patient with a confirmed diagnosis of a malignant neoplasm when the service is provided by a specialist in medical oncology or hematology.
- Apply this code when performing a comprehensive assessment and treatment planning for a new cancer patient, provided the service meets the requirements for a formal consultation as defined in the Schedule of Benefits.
Common Pitfalls
- Billing T369 in conjunction with a minor assessment code like A007 for the same patient on the same day will trigger a rejection for duplicate service.
- Attempting to bill T369 when the patient has been seen by another physician in the same group or specialty for the same condition within the preceding 12 months, which should instead be billed as a repeat consultation or a subsequent visit.
Billing Tips
- Ensure the referral source is clearly documented and the consultation request is received prior to the service date to avoid audit recovery of the $206.50 fee.
- If the consultation results in a decision to manage the patient's care long-term, ensure subsequent visits are billed using appropriate follow-up codes rather than repeating T369.
Provider Fee$206.50
Specialist Fee$206.50
Effective: April 1, 2025
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