All codes
T438
T438 – T438
OHIP Other Code · Schedule of Benefits
When to Use
- Use T438 for the surgical repair of a complete or incomplete tear of the rotator cuff when performed as an open or arthroscopic procedure.
- Bill T438 when the procedure is performed as the primary surgical intervention for chronic rotator cuff pathology that has failed conservative management.
Common Pitfalls
- Do not bill T438 in conjunction with other shoulder arthroscopy codes like R437, as this is considered unbundling and will result in a rejection.
- Avoid billing T438 if the procedure is limited to a simple debridement or subacromial decompression, which should be billed under R437 instead.
Billing Tips
- Ensure the operative report clearly details the specific tendons repaired to justify the T438 fee over lesser shoulder procedures.
- If an additional unrelated procedure is performed during the same session, ensure the secondary code is appended with the appropriate M-code modifier to avoid automatic rejection.
Provider Fee$892.68
Specialist Fee$892.68
Effective: April 1, 2025
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