All codes
T376
T376 – T376
OHIP Other Code · Schedule of Benefits
When to Use
- Use T376 for the surgical repair of a complete or incomplete cleft palate, typically performed by a plastic surgeon or otolaryngologist.
- Apply this code when performing a primary palatoplasty in a pediatric patient to address velopharyngeal insufficiency or anatomical defects.
Common Pitfalls
- Billing T376 in conjunction with other major surgical procedures without ensuring the surgical assistant or multiple procedure rules are applied correctly to avoid automatic rejection.
- Failing to include the necessary diagnostic codes related to congenital anomalies (e.g., Q35 series) which can trigger manual review or rejection for this high-value procedure.
Billing Tips
- Ensure that the operative report clearly details the complexity of the repair, as T376 is subject to audit for medical necessity regarding the extent of the cleft involvement.
Provider Fee$220.33
Specialist Fee$220.33
Effective: April 1, 2025
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