All codes
T401
T401 – T401
OHIP Other Code · Schedule of Benefits
When to Use
- Use T401 for the initial assessment of a patient presenting with a specific minor surgical or procedural concern that does not involve a major surgical procedure.
- Apply this code when a patient is referred for a consultation regarding a dermatological lesion or minor soft tissue issue that requires an examination but not an immediate excision.
- Select T401 when the encounter is strictly for the evaluation of a condition that falls under the minor surgical category, distinguishing it from a standard A007 office visit.
Common Pitfalls
- Billing T401 in conjunction with a minor surgical procedure code (e.g., Z300 series) on the same day will result in a rejection, as the assessment is considered included in the procedure fee.
- Using T401 for a general internal medicine or chronic disease follow-up is an audit risk, as it is strictly intended for minor surgical or procedural-related assessments.
- Submitting T401 when the patient is already under active care for the same condition can lead to claims being flagged for 'unbundling' or duplicate billing.
Billing Tips
- If a minor procedure is performed during the same visit, bill only the procedure code (e.g., Z300) and omit T401, as the assessment is bundled into the procedural fee.
- Ensure the diagnostic code linked to T401 specifically reflects a minor surgical condition to justify the use of this code over a standard general assessment code.
Provider Fee$37.12
Specialist Fee$44.54
Effective: April 1, 2025
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