All codes
T395
T395 – T395
OHIP Other Code · Schedule of Benefits
When to Use
- Use T395 for the formal consultation of a patient referred by another physician or nurse practitioner for a comprehensive assessment of a complex condition.
- Apply this code when the consultation requires a written report back to the referring provider, distinguishing it from a simple A007 intermediate assessment.
Common Pitfalls
- Billing T395 when the patient has been seen by the same physician or a partner in the same group for the same condition within the previous 12 months, which should be billed as a repeat assessment.
- Failing to include the referring physician's billing number on the claim, which will result in an automatic rejection by the Ministry.
Billing Tips
- Ensure the referral is documented as a formal request for consultation rather than a simple transfer of care, as T395 is strictly for the initial consultative service.
Provider Fee$228.30
Specialist Fee$228.30
Effective: April 1, 2025
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