All codes
T403
T403 – T403
OHIP Other Code · Schedule of Benefits
When to Use
- Use T403 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive history and physical examination.
- Apply this code when providing a formal consultation requested by a referring physician for a patient with a complex oncological presentation that exceeds the scope of a standard A005 or A007 assessment.
Common Pitfalls
- Billing T403 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 instead be billed as a repeat consultation or assessment.
- Failing to include the referring physician's billing number on the claim, which is a mandatory requirement for all consultation codes to be processed successfully.
Billing Tips
- Ensure the consultation request is documented in the patient chart with a clear indication of the referring physician's name and the specific clinical question to justify the higher fee over a standard assessment.
Provider Fee$186.37
Specialist Fee$186.37
Effective: April 1, 2025
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