All codes
T420
T420 – T420
OHIP Other Code · Schedule of Benefits
When to Use
- Use T420 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of diagnostic investigations and treatment planning.
- Apply this code when providing a formal consultation for a patient referred by another physician specifically for the management of a complex oncological condition.
Common Pitfalls
- Billing T420 in conjunction with a minor assessment code like A007 is a common rejection trigger, as T420 is intended for a comprehensive consultation service.
- Submitting T420 without a valid referring physician number or failing to document the referral request in the patient chart will lead to automatic claim reversal during audit.
Billing Tips
- Ensure the consultation note explicitly documents the referral source and the clinical question posed to justify the higher fee compared to a standard A005 or A007 assessment.
Provider Fee$275.33
Specialist Fee$275.33
Effective: April 1, 2025
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