All codes
T435
T435 – T435
OHIP Other Code · Schedule of Benefits
When to Use
- Use T435 for the initial consultation of a patient referred for a complex assessment of a specific condition that requires a comprehensive history and physical examination.
- Select T435 when the patient has been referred by another physician or nurse practitioner for a formal opinion that exceeds the scope of a standard A007 intermediate assessment.
Common Pitfalls
- Billing T435 when the patient has been seen by the same physician or a partner in the same group for the same diagnosis within the previous 12 months, which should instead be billed as a repeat consultation or assessment.
- Failing to include the referring physician's billing number on the claim, which will result in an automatic rejection by the Ministry.
Billing Tips
- Ensure the referral note is dated prior to the service date to validate the consultation status, as T435 cannot be billed for self-referred patients or walk-in encounters.
Provider Fee$150.77
Specialist Fee$150.77
Effective: April 1, 2025
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