All codes
T394
T394 – T394
OHIP Other Code · Schedule of Benefits
When to Use
- Use T394 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 formal closure of the palatal defect, distinguishing it from minor revisions or secondary procedures that may fall under different surgical codes.
Common Pitfalls
- Billing T394 in conjunction with other surgical codes for the same site may trigger a rejection for unbundling; ensure all secondary procedures are distinct and medically necessary.
- Failure to include the appropriate diagnostic code for the cleft palate type can lead to claim rejection, as OHIP requires specific ICD-9 coding for congenital anomalies.
Billing Tips
- If the procedure is performed in a hospital setting, ensure the facility number is correctly appended to avoid payment delays associated with site-specific billing requirements.
Provider Fee$465.59
Specialist Fee$465.59
Effective: April 1, 2025
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