All codes
T425
T425 – T425
OHIP Other Code · Schedule of Benefits
When to Use
- Use T425 for the professional fee associated with the insertion of a permanent pacemaker system, specifically for a dual-chamber device.
- Apply this code when the procedure is performed in an operating room or cardiac catheterization lab setting as the primary surgical intervention.
Common Pitfalls
- Billing T425 in conjunction with other surgical procedure codes that are considered inclusive of the pacemaker insertion, leading to automatic claim rejection.
- Failing to ensure the patient's diagnostic history supports the necessity of a dual-chamber system, which may trigger a post-payment audit for medical necessity.
Billing Tips
- Ensure that the associated technical fee or facility fee is billed separately by the hospital, as T425 covers only the physician's professional service.
Provider Fee$1,680.65
Specialist Fee$1,680.65
Effective: April 1, 2025
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