All codes
T385
T385 – T385
OHIP Other Code · Schedule of Benefits
When to Use
- Use T385 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 closure of the palatal defect, including the mobilization of mucoperiosteal flaps, separate from any secondary revision procedures.
- Select T385 when the primary objective is the functional and anatomical reconstruction of the hard and soft palate in a pediatric patient.
Common Pitfalls
- Billing T385 in conjunction with other palatal procedures that are considered inclusive under the Schedule of Benefits, leading to automatic rejection for unbundling.
- Failing to document the specific complexity or extent of the cleft, which may be required during an audit to justify the high-value fee.
- Submitting T385 when the procedure is actually a secondary revision or pharyngoplasty, which requires different, lower-valued codes.
Billing Tips
- Ensure that the operative report clearly details the closure technique, as this is the primary documentation required to defend the T385 claim against audit inquiries regarding procedure scope.
Provider Fee$2,532.63
Specialist Fee$2,532.63
Effective: April 1, 2025
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