All codes
T423
T423 – T423
OHIP Other Code · Schedule of Benefits
When to Use
- Use T423 for the initial consultation of a patient with a suspected or confirmed malignancy when the service is provided by a specialist in medical oncology or hematology.
- Apply this code when the clinical encounter involves a comprehensive assessment, review of diagnostic pathology, and the formulation of a complex treatment plan for a new cancer diagnosis.
Common Pitfalls
- Billing T423 in conjunction with a minor assessment code like A007 for the same patient on the same day will trigger a rejection for duplicate service.
- Using T423 for a follow-up visit instead of the appropriate subsequent visit code will lead to audit recovery as T423 is strictly for the initial consultation.
Billing Tips
- Ensure the referral source is clearly documented and valid, as T423 requires a formal request from another physician to be eligible for payment.
- If the consultation exceeds the time threshold for a standard assessment, consider whether the complexity warrants a specific time-based modifier if applicable to your specialty.
Provider Fee$215.14
Specialist Fee$215.14
Effective: April 1, 2025
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