All codes
T404
T404 – T404
OHIP Other Code · Schedule of Benefits
When to Use
- Use T404 for the initial assessment of a patient with a suspected or confirmed malignancy when you are the primary consultant providing a comprehensive evaluation.
- Apply this code when performing a detailed consultation for a patient referred by another physician for a new oncological concern, provided the patient has not been seen by you for this condition in the previous 12 months.
Common Pitfalls
- Billing T404 when the patient has been seen by you or a member of your same-specialty group for the same diagnosis within the last year, which requires a repeat consultation code instead.
- Submitting T404 without a valid referring physician number, as this code strictly requires a formal referral to be payable by OHIP.
Billing Tips
- Ensure the referral date is clearly documented and matches the date of service to avoid automated rejections for missing or invalid referral information.
Provider Fee$159.74
Specialist Fee$159.74
Effective: April 1, 2025
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