All codes
T427
T427 – T427
OHIP Other Code · Schedule of Benefits
When to Use
- Use T427 for the surgical repair of a complete or incomplete rotator cuff tear when performed as a primary procedure.
- Apply this code when the repair involves formal reattachment of the tendon to the humeral head, distinguishing it from simple debridement (which would be billed under a different arthroscopic code).
- Select T427 when the procedure is performed via open or mini-open approach, as it is the specific fee schedule item for this surgical intervention.
Common Pitfalls
- Billing T427 in conjunction with arthroscopic debridement codes is often rejected as the debridement is considered bundled into the primary repair.
- Submitting T427 without clear documentation of the tear size and specific fixation method (e.g., suture anchors) frequently triggers manual review or audit inquiries.
- Attempting to bill T427 alongside other shoulder procedures without checking the Schedule of Benefits for mutually exclusive codes often leads to automatic claim rejection.
Billing Tips
- Ensure the operative report explicitly details the extent of the tear and the technique used to reattach the tendon to the bone to justify the T427 fee.
- If a secondary procedure is performed during the same session, verify if it is eligible for 50% reduction or if it is considered inclusive to the primary T427 repair.
Provider Fee$787.97
Specialist Fee$787.97
Effective: April 1, 2025
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