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T393
T393 – T393
OHIP Other Code · Schedule of Benefits
When to Use
- Use T393 for the surgical repair of a complete or incomplete cleft palate, typically performed in a hospital setting.
- Apply this code when the procedure involves the formal closure of the palatal defect, distinguishing it from minor revisions or secondary soft tissue procedures.
- Select T393 when the clinical documentation confirms a primary palatoplasty procedure rather than a pharyngoplasty or velopharyngeal insufficiency correction.
Common Pitfalls
- Billing T393 in conjunction with other cleft-related procedures without ensuring the services are not considered 'included' under the Schedule of Benefits global fee rules.
- Submitting T393 for secondary palatal revisions, which should be billed under a different specific code if the primary repair has already been completed.
- Failing to include the appropriate diagnostic code for the congenital cleft palate, which can lead to automated rejections for lack of medical necessity.
Billing Tips
- Ensure the operative report clearly details the complexity of the repair to justify the high-value fee if audited against standard primary closure benchmarks.
- Verify that no other surgical codes for the same anatomical site are billed on the same day unless they represent distinct, non-overlapping procedures that permit separate claiming.
Provider Fee$492.83
Specialist Fee$492.83
Effective: April 1, 2025
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