All codes
T468
T468 – T468
OHIP Other Code · Schedule of Benefits
When to Use
- Use T468 for the professional fee associated with the insertion of a permanent pacemaker pulse generator when the procedure is performed in an operating room setting.
- Apply this code when billing for the surgical component of a pulse generator replacement or upgrade, distinct from the lead placement or revision codes.
Common Pitfalls
- Billing T468 in conjunction with Z501 or other minor procedure codes is often rejected as the global surgical fee is intended to cover the primary procedure.
- Failure to include the appropriate diagnostic code or the specific surgical facility number can lead to automatic rejections for this high-value procedure code.
Billing Tips
- Ensure the claim includes the correct surgical assistant code if applicable, as T468 is eligible for assistant premiums when the complexity of the generator change requires a second physician.
Provider Fee$140.94
Specialist Fee$140.94
Effective: April 1, 2025
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