All codes
T440
T440 – T440
OHIP Other Code · Schedule of Benefits
When to Use
- Use T440 for the initial consultation of a patient with a suspected or confirmed malignancy when the service is provided by a specialist in medical oncology or hematology.
- Apply this code when the clinical encounter includes a comprehensive review of pathology, staging, and the development of a complex multi-modal treatment plan that requires significant time beyond a standard consultation.
- Select T440 instead of A005 when the complexity of the oncological diagnosis necessitates a detailed discussion of systemic therapy options, clinical trial eligibility, and prognosis.
Common Pitfalls
- Billing T440 in conjunction with a subsequent visit code (A007) on the same day is prohibited and will result in an automatic rejection.
- Failure to document the specific oncological diagnosis or the complexity of the treatment plan often leads to audit recovery if the clinical notes do not support the higher fee compared to a standard consultation.
- Using T440 for follow-up visits or routine monitoring of stable patients is an incorrect application; these should be billed under appropriate subsequent visit codes.
Billing Tips
- Ensure the referral note is clearly linked to the T440 claim, as the Ministry frequently audits these high-value codes to verify the legitimacy of the specialist consultation request.
- If the consultation requires an exceptionally long duration, ensure the start and end times are documented to justify the use of T440 over lower-valued consultation codes.
Provider Fee$483.57
Specialist Fee$604.13
Effective: April 1, 2025
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