All codes
T415
T415 – T415
OHIP Other Code · Schedule of Benefits
When to Use
- Use T415 for the initial assessment and management of a patient presenting with a specific acute minor illness or injury that does not meet the criteria for a comprehensive assessment.
- Select T415 when providing a focused consultation for a single system complaint that requires a brief physical examination and management plan, distinct from the more extensive A007 or A005 codes.
Common Pitfalls
- Billing T415 in conjunction with a K-code (such as K030) on the same day for the same patient is frequently rejected as the assessment is considered inclusive of the counseling.
- Using T415 for routine follow-up visits is an audit risk; use the appropriate minor assessment code (A001) instead to reflect the nature of the encounter.
Billing Tips
- Ensure the clinical note explicitly supports the complexity of the assessment to justify T415 over a standard minor assessment code if questioned during a post-payment review.
Provider Fee$48.90
Specialist Fee$48.90
Effective: April 1, 2025
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