All codes
T416
T416 – T416
OHIP Other Code · Schedule of Benefits
When to Use
- Use T416 for the initial consultation of a patient referred for a specific psychiatric assessment when the patient is seen in a hospital outpatient setting.
- Apply this code when performing a comprehensive psychiatric evaluation that exceeds the scope of a standard K013 psychotherapy session but does not meet the criteria for a full psychiatric consultation (A195).
- Utilize T416 when the service involves a detailed diagnostic interview and management plan formulation for a patient with complex mental health needs.
Common Pitfalls
- Billing T416 on the same day as a K013 or K015 psychotherapy code is a common cause for rejection, as these services are considered mutually exclusive.
- Submitting T416 for a routine follow-up visit is an audit risk; use K013 or a standard office visit code for ongoing management instead.
- Failing to document the specific referral source or the clinical complexity can lead to recovery during a Ministry audit.
Billing Tips
- Ensure the clinical note clearly distinguishes the diagnostic nature of the T416 encounter from routine supportive therapy to justify the higher fee compared to standard visit codes.
Provider Fee$48.90
Specialist Fee$48.90
Effective: April 1, 2025
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