All codes
T402
T402 – T402
OHIP Other Code · Schedule of Benefits
When to Use
- Use T402 for the initial consultation of a patient referred by another physician for a specific diagnostic or therapeutic problem within the specialty of Internal Medicine.
- Apply this code when the patient has not been seen by you for the same condition within the previous 12 months, distinguishing it from a repeat consultation (T403).
- Select T402 when the referral request requires a comprehensive assessment and a written report back to the referring physician, rather than a simple office visit (A007).
Common Pitfalls
- Billing T402 when the patient has been seen by you or a partner in the same group for the same diagnosis within the last 12 months, which should be billed as a repeat consultation (T403) or a follow-up (A005).
- Failure to maintain a formal written referral from the primary care provider or another specialist, which is a mandatory requirement for all consultation codes.
- Submitting T402 for a patient who is already under your active care for the same condition, as this constitutes a follow-up visit rather than a new consultation.
Billing Tips
- Ensure the referral date and the referring physician's billing number are accurately recorded in your claim, as these are primary audit triggers for consultation codes.
- If the consultation results in a procedure, you may bill the procedure code in addition to T402, provided the assessment was distinct and necessary to determine the need for the procedure.
Provider Fee$87.42
Specialist Fee$104.90
Effective: April 1, 2025
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