All codes
T426
T426 – T426
OHIP Other Code · Schedule of Benefits
When to Use
- Use T426 for a formal consultation requested by a referring physician for a patient with a complex hematological condition.
- Apply this code when the consultation involves a comprehensive review of clinical records, a physical examination, and a written report back to the referring physician.
Common Pitfalls
- Billing T426 when the service provided is a repeat visit or follow-up, which should instead be billed as A426.
- Failing to ensure the referring physician's billing number is included in the claim, as T426 requires a valid referral to be eligible for payment.
Billing Tips
- Ensure the consultation report is sent to the referring physician within a reasonable timeframe, as the Ministry may audit for the existence of this correspondence.
Provider Fee$140.94
Specialist Fee$140.94
Effective: April 1, 2025
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