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T463
T463 – T463
OHIP Other Code · Schedule of Benefits
When to Use
- Use T463 for the surgical repair of a complete or incomplete rotator cuff tear when performed as a primary procedure.
- Bill this code when the procedure is performed via open or mini-open approach, as arthroscopic repairs typically fall under different procedural codes.
Common Pitfalls
- Billing T463 in conjunction with other shoulder procedures like subacromial decompression (S250) without proper documentation of separate incisions or distinct pathology may lead to rejection for unbundling.
- Submitting T463 for simple debridement or synovectomy is an audit risk, as this code specifically requires the repair of the rotator cuff tendon to the bone.
Billing Tips
- Ensure the operative report explicitly details the reattachment of the tendon to the humerus to justify the T463 fee over lesser soft tissue procedures.
Provider Fee$290.85
Specialist Fee$290.85
Effective: April 1, 2025
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